Approximately one third of all men diagnosed and treated for prostate cancer will experience a recurrence of their prostate cancer! This is a shocking number, but it is a true number. It does not matter what the treatment a man has, the statistic holds up across all treatments.

The first sign of a problem, a recurrence, is seen by changes in a stable PSA. After treatment PSA levels reach a stable number called the nadir. If things are going along the way we like this nadir score never changes, however if it begins to rise we need to be concerned that the prostate cancer has found a comfortable place to re-grow.

It is vital to quickly become aware of the possibility of a recurrence, so men need to stay vigilant in monitoring their PSA post treatment. Do not confuse the recent controversy about the value of PSA for diagnosis purposes with the value of PSA post treatment. After treatment your PSA is an excellent indicator of a prostate cancer recurrence.

With a rise from the nadir score it is sometimes possible to still deal a deathblow to prostate cancer as long as we can locate where the cancer is located. This means being able to accurately find the cancer by the use of scans.

Historically, our scans have not been very accurate in finding this new cancer growth while it is small and still in a localized small area of the body like the tissue left surrounding where the prostate gland prior had been prior to treatment.

We now have a few alternative types of scans that demonstrates a higher capacity of finding the prostate cancer recurrence. One of these newer scans that seems to be able to map recurrent prostate cancer better than the more traditional integrated positron emission tomography and computed tomography has been described at the recent Society of Nuclear Medicine and Molecular Imaging annual meeting in Vancouver, Canada.

At the meeting researchers presented a comparative study where recurrent prostate cancer was imaged both with positron emission tomography/magnetic resonance and positron emission tomography/computed tomography (PET/CT) with the molecular imaging agent C-11 choline, which was approved for this use by the FDA last year.

They reported that the “The combination of PET with C-11 choline, and functional MRI provides complementary information that increases diagnostic certainty with higher detection rates, especially for more precise localization of recurrence.

This information can guide the development of a better tailored specific therapy; eg, radiation of the pelvis versus ADT for prostate cancer still in the localized tissue.

According to the lead author Matthias Eiber, MD, of Technical University Munich in Munich, Germany
this study incorporated 31 men who had both PET/CT and PET/MR performed for restaging of recurrent prostate cancer with a single injection of the imaging agent C-11 choline. PET/CT scans occurred about 5 minutes after injection, and PET/MR scans occurred about 51 minutes after injection. Scans were interpreted separately, and all detected lesions were categorized according to suspected metastases as definitely, probably, or indeterminately metastatic.

The authors found that PET/MR found more areas of metastases—17 in 12 different men—when compared to PET/CT, which found 12 areas of metastases in eight subjects. PET/MR also found more lymph node metastases: 42 versus 39 areas of interest with PET/CT. The same held true for bone metastases, which were detected in 17 areas for five patients with PET/MR and 14 areas for four patients with PET/CT.

The other really good finding is that PET/MR is associated with considerably lower radiation exposure compared to PET/CT. Since many of us will often get a series of examinations in the course of our disease treatment, radiation control could be another argument for the promotion of PET/MR.

“In principle, whole-body integrated PET/MR is a technique that is officially commercially available; however, so far only a limited number of these scanners have been installed worldwide,” said Dr. Eiber. “Showing a concrete example of how combining PET and functional MR imaging benefits patients with metastatic prostate cancer could potentially motivate continued PET/MR research in this field.” Hopefully this study will also encourage additional facilities to purchase and use the machines required to perform these scans.

Don’t forget, go to: to support a prostate cancer research project that speaks to you.

Joel T Nowak, M.A., M.S.W.