Imaging of prostate cancer local recurrences: why and how?
OBJECTIVE
Because prostate cancer local recurrences can be efficiently treated by salvage therapies, it becomes critical to detect them early.


METHODS
The first alert is the rise of the prostate specific antigen (PSA) level after the post-treatment nadir, which can correspond to a distant recurrence, a local recurrence or both. This so-called biochemical failure (BF) is defined as PSA level > 0.2 ng/ml after radical prostatectomy (RP) and PSA level > nadir + 2 ng/ml after radiotherapy. There is no consensual definition of BF after cryotherapy, high-intensity focused ultrasound (HIFU) ablation or brachytherapy.


RESULTS
Local recurrences after RP are treated by radiotherapy, those after radiotherapy by RP, cryotherapy, brachytherapy or HIFU ablation. Recurrences after cryotherapy or HIFU ablation can be treated by a second session or radiotherapy. Recurrences after brachytherapy are difficult to treat. In patients with BF, MRI can detect local recurrences, whatever the initial treatment was. Dynamic contrast-enhanced MRI seems particularly accurate. The role of spectroscopy remains controversial. Ultrasound-based techniques are less accurate, but this may change with the advent of ultrasonic contrast media.


CONCLUSIONS
These recent advances in imaging may improve the outcome of salvage therapies (by improving patient selection and treatment targeting) and should open the way to focal salvage treatments in the near future.
Rouvière
Olivier
O
Université de Lyon, Lyon, 69003, France. olivier.rouviere@netcourrier.com
Vitry
Thierry
T
Lyonnet
Denis
D
D015415:Biomarkers / Q000097:blood; D003287:Contrast Media; D003952:Diagnostic Imaging; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000628:therapy*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D016879:Salvage Therapy
D015415:Biomarkers; D003287:Contrast Media; D017430:Prostate-Specific Antigen