Localizing sites of disease in patients with rising serum prostate-specific antigen up to 1ng/ml following prostatectomy: How much information can conventional imaging provide?
PURPOSE
Accurate identification of the source of a detectable serum prostate-specific antigen (PSA) in the postprostatectomy setting is a major challenge among the urologic community. The aim of this study was to assess positivity rates of imaging examinations performed in patients with early PSA rise after prostatectomy and to summarize the management strategies adopted in this clinical scenario.


METHODS
Institutional Review Board-approved retrospective study of 142 postprostatectomy patients with PSA rise up to 1ng/ml who underwent evaluation with combination of multiparametric pelvic magnetic resonance imaging (MRI)±whole-body or bone MRI, bone scintigraphy, computed tomography (CT) chest-abdomen-pelvis, 18F-fludeoxyglucose-positron emission tomography (PET)/CT or 18F-sodium fluoride-PET/CT at a single tertiary cancer center. Imaging results were summarized per modality and compared with pathology findings.


RESULTS
Pelvic MRI was positive in 15/142 (11%) patients (14 patients with local recurrence in the surgical bed and 1 patient with pelvic osseous metastases). Of these 15, 10 patients underwent additional imaging examinations; none revealed positive findings. Of the 127 patients with negative pelvic MRI, 54 (43%) underwent additional imaging examinations; only 1/54 had positive findings (false-positive T8 lesion on bone scintigraphy and FDG-PET/CT; biopsy was negative for cancer). Overall, 12/16 patients with positive imaging findings and 75/126 (60%) patients with negative imaging received treatment (radiation, hormones or chemotherapy).


CONCLUSION
The conventional imaging identified sites of disease, almost always in the form of local recurrence, in a minority of patients with early PSA rise postprostatectomy.
['Vargas|Hebert Alberto|HA|', 'Martin-Malburet|Alexandre G|AG|', 'Takeda|Toshikazu|T|', 'Corradi|Renato B|RB|', 'Eastham|James|J|', 'Wibmer|Andreas|A|', 'Sala|Evis|E|', 'Zelefsky|Michael J|MJ|', 'Weber|Wolfgang A|WA|', 'Hricak|Hedvig|H|']
D000230:Adenocarcinoma D000368:Aged D001859:Bone Neoplasms D003131:Combined Modality Therapy D005462:Fluorine Radioisotopes D019788:Fluorodeoxyglucose F18 D006801:Humans D008279:Magnetic Resonance Imaging D008297:Male D008875:Middle Aged D009364:Neoplasm Recurrence, Local D000072078:Positron Emission Tomography Computed Tomography D049268:Positron-Emission Tomography D011184:Postoperative Period D017430:Prostate-Specific Antigen D011468:Prostatectomy D011471:Prostatic Neoplasms D019275:Radiopharmaceuticals D012189:Retrospective Studies D016879:Salvage Therapy D012969:Sodium Fluoride D059039:Standard of Care
MRI CT Recurrence Bone scan PET Prostate cancer