Pelvic MRI findings in relapsed prostate cancer after radical prostatectomy
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RESEARCH
Open Access
Pelvic MRI findings in relapsed prostate cancer after radical prostatectomy D. Hernandez2, D. Salas3, D. Giménez1, P. Buitrago1, S. Esquena3, J. Palou3, P. de la Torre4, J. Pernas2, I. Gich5, G. Gómez de Segura1, J. Craven-Bartle1 and G. Sancho1*
Abstract Purpose/Objective: Little is known about the clinical impact of using multiparametric MRI to plan early salvage radiotherapy after radical prostatectomy. We aimed to evaluate the incidence and location of recurrence based on pelvic multiparametric MRI findings and to identify clinical variables predictive of positive imaging results. Materials and methods: We defined radiological criteria of local and lymph node malignancy and reviewed records and MRI studies of 70 patients with PSA recurrence after radical prostatectomy. We performed univariate and multivariate analysis to identify any association between clinical, pathological and treatment-related variables and imaging results. Results: Multiparametric MRI was positive in 33/70 patients. We found local and lymph node recurrence in 27 patients and 7 patients, respectively, with a median PSA value of 0.38 ng/ml. We found no statistically significant differences between patients with positive and negative multiparametric MRI for any variable. Shorter PSADT was associated with positive lymph nodes (median PSADT: 5.12 vs 12.70 months; p: 0.017). Conclusions: Nearly half the patients had visible disease in multiparametric MRI despite low PSA. Positive lymph nodes incidence should be considered when planning salvage radiotherapy, particularly in patients with a short PSADT. Keywords: Radical prostatectomy, Biochemical failure, Multiparametric MRI, Salvage radiotherapy
Introduction Radical prostatectomy is the gold standard treatment for localized prostate cancer, but depending on the pathologic tumor stage, up to 60 % of patients who undergo radical prostatectomy develop biochemical recurrence and require further treatment [1]. Salvage radiotherapy is the only treatment with curative intention for these patients and has been associated with a three-fold increase in prostate cancer-specific survival when compared with observation [2]. Despite these good results, around 50 % patients have recurrence in the ten years after salvage radiotherapy [3]. Major factors contributing to the high risk of progression after radiotherapy are: 1) uncertainty about the best time to perform adjuvant or salvage radiotherapy [4]; 2) difficulties locating the site of recurrence; 3) the risk of * Correspondence: [email protected] 1 Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041 Barcelona, Spain Full list of author information is available at the end of the article
missing subclinical disease when defining the clinical target volume (CTV); and 4) the possibility of delivering insufficient radiation dose. Several studies [5–8] have investigated the accuracy of endorectal coil MRI for detecting local recurrence after radical prostatec
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