Abstract
Context
Local and regional recurrence after radical prostatectomy (RP) can be treated using
salvage radiotherapy (SRT). If the recurrence can be delineated on diagnostic imaging,
this could allow for increasingly individualized SRT.
Objective
This systematic review aimed at evaluating the evidence regarding the usefulness of
positron emission tomography (PET) and magnetic resonance imaging (MRI) in identifying
local and regional recurrences, with the aim to further individualize the SRT treatment.
Evidence acquisition
A systematic PubMed/Medline search was conducted in December 2015. Studies included
were imaging studies of post-RP patients focusing on local and/or regional recurrence
where sensitivity and specificity of MRI or PET were the primary end points. Only
studies using biopsy, other histological analysis, and/or treatment follow-up as reference
standard were included. Quality Assessment of Diagnostic Accuracy Studies-2 was used
to score the study quality. Twenty-five articles were deemed of sufficient quality
and included in the review.
Evidence synthesis
[11C]Acetate had the highest pooled sensitivity (92%), while [11C]choline and [18F]choline had pooled sensitivities of 71% and 84%, respectively. The PET tracer with
highest pooled specificity was [11C]choline (86%). Regarding MRI, MR spectroscopy combined with dynamic contrast enhanced
(DCE) MRI showed the highest pooled sensitivity (89%). High pooled sensitivities were
also seen using multiparametric MRI (84%), diffusion-weighted MRI combined with T2-weigthed
(T2w) imaging (82%), and DCE MRI combined with T2w imaging (82%). These also showed
high pooled specificities (85%, 89%, and 92%, respectively).
Conclusions
Both MRI and PET have adequate sensitivity and specificity for the detection of prostate
cancer recurrences post-RP. Multiparametric MRI, using diffusion-weighted and/or DCE
imaging, and the choline-labeled tracers showed high pooled sensitivity and specificity,
although their ranges were broad.
Patient summary
After reviewing imaging studies of recurrent prostate cancer after prostatectomy,
we concluded that choline positron emission tomography and diffusion-weighted magnetic
resonance imaging can be proposed as the current standard, with high sensitivity and
specificity.
Keywords
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Article Info
Publication History
Published online: November 10, 2017
Associate Editor: Derya TilkiIdentification
Copyright
© 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.
