Targeting Local Recurrence After Surgery With MRI Imaging for Prostate Cancer in the Setting of Salvage Radiation Therapy

Abstract

Magnetic resonance imaging (MRI) is being increasingly used for imaging suspected recurrence in prostate cancer therapy. Functional MRI with diffusion and perfusion imaging has the potential to demonstrate local recurrence even at low PSA value. Detection of recurrence can modify the management of postprostatectomy biochemical recurrence. MRI scan acquired before salvage radiotherapy is useful for the localization of recurrent tumors and also in the delineation of the target volume. The objective of this review is to assess the role and potential impact of MRI in targeting local recurrence after surgery for prostate cancer in the setting of salvage radiation therapy.

Prostate-Specific Antigen as an Ultrasensitive Biomarker for Patients with Early Recurrent Prostate Cancer: How Low Shall We Go? A Systematic Review

“…Only a few patients had positive findings with multiparametric MRI when the patients were restaged at rising PSA < 300 ng/L [157].…”

ESTRO ACROP consensus recommendation on the target volume definition for radiation therapy of macroscopic prostate cancer recurrences after radical prostatectomy

“…Therefore, the panel strictly advised to only consider dose-escalation or focal boosting if an anatomical correlate was visible. Obviously, pathology validation would be best, but the suspect areas are typically very small and the biopsy yield is consequently very low [2] .…”

“…Multi-parametric magnetic resonance imaging (mpMRI), typically with diffusion-weighted (DW) and/or diffusion contrast-enhanced (DCE) sequences, is the gold standard for local re-staging after radical prostatectomy, with a sensitivity and specificity above 90% [2] . Indeed, the Prostate Imaging for Recurrence Reporting (PI-RR) assessment system has been recently proposed to standardize the acquisition, interpretation, and reporting of mpMRI for prostate cancer recurrence detection, both after radical prostatectomy and radiation therapy [3] .…”

Prostate Imaging for Local Recurrence Reporting and Data System for Biparametric Magnetic Resonance Imaging: A Proposal

“… The biochemical relapse of prostate cancer after local therapy was diagnosed according to EAU-ESTRO-SOG guidelines. Relapse after local therapy is defined by a rising PSA level > 0.2 ng/mL following RP and >2 ng/mL above the nadir after RT 20 - 22 . PI-RRADS, Prostate Imaging for Local Recurrence Reporting and Data System.…”

“…Unlike PCa, the PCLR after RP and RT in the prostatectomy bed or in prostate gland, respectively, is characterized by an increase in cell density that can be detected on DWI/ADC as a restricted diffusion area. 6 , 17 - 21 …”