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MultiparametricMRI is superior to PET and CT scanning for
diagnosing prostate cancer recurrence after radical prostatectomy
M
ultiparameteric MRI has been
shown to be superior to PET and
CT scanning in patients with
biochemical recurrence of prostate cancer
after radical prostatectomy.
This was the outcome of a comparative study
of diagnostic imaging methods in patients
with suspected local relapse of prostate
cancer after radical prostatectomy.
F. Kossov, MD, of the Russian Onkology
Research Center, Moscow, explained that
clinical suspicion of local recurrence of
prostate cancer after radical prostatectomy
is based on the onset
of biochemical failure.
Multiparametric MRI is one of
the best methods of identifying
local manifestations of
disease progression. Such
identification is particularly
relevant in patients suitable
for salvage radiotherapy.
P r o s t a t e T2 - we i g h t e d
imaging, diffusion-weighted
imaging with apparent
diffusion coefficient, and
dynamic contrast-enhanced
T1-weighted imaging were
obtained (diffusion-weighted
imaging, b = 50–1000–1500;
and b = 50–1500–2000) in
patients suspicious for local
relapse of prostate cancer after
radical prostatectomy before
salvage radiotherapy.
Eighty-seven patients with bio-
chemical relapse of prostate
cancer after radical prosta-
tectomy were examined by
multiparametric MRI. Local
recurrence of prostate cancer
was diagnosed in 42 cases.
MRI characteristics of can-
cer recurrence were the same
as for the primary prostate
cancer:
•
Additional tissue size 4–8 mm in the zone
of removed prostate
•
Hypointense signal on T2-weighted
imaging
•
Hyperintense signal on diffusion-weighted
imaging with high b value and hypointense
signal on apparent diffusion coefficient
mapping
•
Fast and high local uptake during dynamic
contrast-enhanced MRI.
MR contrast agent pharmacokinetics changed
dramatically in the background of hormone
therapy. PET and CT scanning showed bone
metastasis in 18 patients from 45 cases in
which multiparametric MRI had not revealed
local prostate recurrence. The combination of
hormone therapy and subsequent salvage radi-
otherapy improved the efficacy of treatment for
local prostate cancer recurrence.
Multiparametric MRI is unique among
diagnostic radiationmethods for the evaluation
of patients with biochemical recurrence of
prostate cancer after radical prostatectomy.
Salvage radiotherapy also serves as a method
for verifying the diagnosis. If local recurrence
of the tumour is suspected at the site of
removed prostate, multiparametricMRI allows
for the choice of therapy.
Relapses of prostate cancer were characterised
by hypointense signal on T2-weighted
imaging, diffusion-weighted imaging, and
decreased diffusion coefficient on the
apparent diffusion coefficient, high-speed
storage coefficient, and absolute maximum
signal intensity on dynamic contrast-
enhanced MRI. The results showed that the
full complex of MRI methods increased the
efficiency of diagnosis of local recurrence of
prostate cancer after radical prostatectomy.
Dr Kossov concluded that, whendiagnosing local
recurrence of prostate cancer in the early stages
of recurrence, multiparametric MRI is superior
to PET andCT scanning.MultiparametricMRI
is optimal in patients with biochemical relapse
when local tumour recurrence is suspected, even
amid negative results of integrated transrectal
ultrasonography. Multiparametric MRI helps
assess the dynamics of local prostate cancer
recurrence after radiotherapy.
PracticeUpdate Editorial Team
Multiparametric MRI is one
of the best methods of
identifying local
manifestations of disease
progression. Such
identification is particularly
relevant in patients suitable
for salvage radiotherapy.
© ECCO2017 European Cancer Congress
ECCO2017
13
VOL. 2 • NO. 2 • 2017