Introduction

11C-choline positron emission tomography (PET) and multiparametric MRI (mpMRI) imaging may be considered for evaluation of PSA recurrence. The pattern of failure following salvage therapy after prostatectomy is poorly understood. The objective of this study is to identify sites of cancer recurrence in patients who received hormonal therapy (HT), radiation therapy (RT) or combination of HT and RT following prostatectomy and subsequently developed PSA progression.

Methods

Between January 2008 and June 2016, 2466 patients underwent imaging for PSA recurrence. From this cohort 216 received RT, HT or RT+HT postoperatively and underwent 11C-choline PET scan and mpMRI. Additionally, clinical factors (ie. PSA at imaging) associated with recurrence were also evaluated. Local recurrence was defined as positive imaging within prostate bed. Metastatic recurrence included recurrent disease of pelvic/distant nodes as well as osseous disease.

Results

Among 216 patients with PSA progression, 26 (12.0%) patients exhibited local recurrence, 34 (15.8%) had local and distant metastatic disease, and 156 (72.2%) had metastatic disease. Table 1 describes patterns of recurrence. Mean PSA was 4.47, 6.87, and 10.63 in patients with local recurrence, local and metastatic recurrence, and metastatic recurrence, respectively (p=0.21). When recurrence patterns were compared with postoperative treatment-naïve patients (Sobol et al JU 2016), patients receiving postoperative therapy had higher rates of metastatic recurrence (72% vs. 44%) while treatment-naïve patients had higher rates of local recurrence (34% vs 12%; both p<0.0001).

Conclusions

Utilization of mpMRI and 11C-choline PET imaging in the evaluation of PSA progression after postoperative therapy reveals varied recurrence patterns, with the majority of patients having evidence of metastatic disease, when compared with a treatment-naïve cohort. Approximately 12% of patients who failed postoperative therapy after prostatectomy may be eligible for additional local therapy. Prudent utilization of advanced imaging techniques may optimize and guide therapeutic options among patients who develop PSA progression following postoperative therapy potentially avoiding unnecessary or ineffective treatments.

Funding

None