Identification of Recurrence Sites Following Post-Prostatectomy Treatment for Prostate Cancer Using (11)C-Choline Positron Emission Tomography and Multiparametric Pelvic MRI

To describe anatomic sites of recurrence among prostate cancer patients with biochemical recurrence following radical prostatectomy (RP) and postoperative radiotherapy (RT) and/or androgen deprivation therapy (ADT) using (11)C-Choline PET/CT and multiparametric-MRI.

RP patients evaluated with (11)C-Choline PET/CT and multiparametric-MRI following RT and/or ADT were evaluated for patterns of recurrence and clinicopathologic features. Recurrent sites were described as either local-only (seminal vesicle bed/prostate fossa, vesicourethral anastomosis and bladder neck) or distant metastatic disease. Features associated with identification of any distant metastatic disease were evaluated using multivariable logistic regression.

A total of 550 patients were identified. Treatment included 108 with ADT, 201 with RT, and 241 with both. Median PSA at evaluation was 3.9, 3.6, and 2.8 ng/mL for patients treated with ADT, RT, or a combination, respectively. 77 patients (14%) recurred locally, 411 (75%) recurred with distant metastasis only, and 62 (11%) recurred with both local and distant metastatic disease. On multivariable analysis, treatment with radiotherapy (OR 7.18; 95%CI 2.92-17.65; p<0.01) and radiotherapy and hormonal therapy (OR 9.23; 95%CI 3.90-21.87; p<0.01) were associated with an increased odds of distant failure at evaluation.

The combination of (11)C-choline PET/CT and multiparametric-MRI successfully identified patterns of recurrence following postoperative RT, ADT, or both, at median PSA less than 4. Half of this cohort had local only recurrence and/or low disease burden limited to pelvic lymph nodes and may benefit from additional local therapy. This data and analysis may facilitate the evaluation of such patients with biochemically recurrent prostate cancer.

The Journal of urology. 2017 Sep 12 [Epub ahead of print]

Avinash Nehra, William P Parker, Rimki Haloi, Sean S Park, Lance A Mynderse, Val J Lowe, Brian J Davis, J Fernando Quevedo, Geoffrey B Johnson, Eugene D Kwon, R Jeffrey Karnes

Department of Urology, Mayo Clinic, Rochester, MN., Department of Radiation Oncology, Mayo Clinic, Rochester, MN., Department of Radiology, Mayo Clinic, Rochester, MN., Department of Medical Oncology, Mayo Clinic, Rochester, MN., Department of Urology, Mayo Clinic, Rochester, MN. Electronic address: .