There has been a lot of conversation about the role of and the use of multi-parametric MRIs in the initial diagnostic stages of prostate cancer, but little is known about its potential clinical application in the use of early salvage radiotherapy after failed radical prostatectomy.
In a study to exam the potential of multi-parametric MRIs in men experiencing surgical failure as defined by a rising PSA post surgery, researchers reviewed the records and MRI studies of 70 men with rising PSA scores post surgery. They evaluated the incidence and location of recurrence based on pelvic multi-parametric MRI findings and to identify clinical variables predictive of positive imaging results.
They found that the multi-parametric MRI was positive in 33 of 70 men and there was local and lymph node recurrence in 27 men and 7 men, respectively, with a median PSA value of 0. 38 ng/ml. They did not find any statistically significant differences between men with positive and negative multi-parametric MRI for any other variable. They also found that shorter PSA doubling time (PSADT) was associated with positive lymph nodes (median PSADT: 5. 12 vs 12. 70 months; p: 0. 017).
The results support the use of multi-parametric MRI to plan salvage radiotherapy after failed radical prostatectomy, even in men with low PSA levels. Nearly half the men had visible disease in the multi-parametric MRI despite their having a low PSA. Positive lymph nodes incidence should be considered when planning salvage radiotherapy, particularly in men with a short PSADT.
Radiation oncology (London, England). 2015 Dec 24 epublish; D Hernandez, D Salas, D Giménez, P Buitrago, S Esquena, J Palou, P de la Torre, J Pernas, I Gich, G Gómez de Segura, J Craven-Bartle, G Sancho
The use of 3 tesla parametric MRI is also useful for defining the possibility of salvage surgery after radiation treatment was selected as the primary treatment. Active tumours and grade were located and described in the remains of my prostate gland and in the bladder neck by this imaging even though my PSA was 0.03. The imaging was also able to define cleavage possibilities between the prostate and rectum to help in deciding if surgery was possible. My result was the removal of the remains of my prostate (prostatectomy) my bladder, lymph nodes and appendix. The pathological results confirmed the original results of the imaging done prior to the surgery.