title: Role of imaging and biopsy to assess local recurrence after definitive treatment for prostate carcinoma (surgery, radiotherapy, cryotherapy, HIFU).
abstract: OBJECTIVE
  Defining the site of recurrent disease early after definitive treatment for a localized prostate cancer is a critical issue as it may greatly influence the subsequent therapeutic strategy or patient management.
  
  
  METHODS
  A systematic review of the literature was performed by searching Medline from January 1995 up to January 2011. Electronic searches were limited to the English language, and the keywords prostate cancer, radiotherapy [RT], high intensity focused ultrasound [HIFU], cryotherapy [CRIO], transrectal ultrasound [TRUS], magnetic resonance [MRI], PET/TC, and prostate biopsy were used.
  
  
  RESULTS
  Despite the fact that diagnosis of a local recurrence is based on PSA values and kinetics, imaging by means of different techniques may be a prerequisite for effective disease management. Unfortunately, prostate cancer local recurrences are very difficult to detect by TRUS and conventional imaging that have shown limited accuracy at least at early stages. On the contrary, functional and molecular imaging such as dynamic contrast-enhanced MRI (DCE-MRI), and diffusion-weighted imaging (DWI), offers the possibility of imaging molecular or cellular processes of individual tumors.                         Recently, PET/CT, using 11C-choline, 18F-fluorocholine or 11C-acetate has been successfully proposed in detecting local recurrences as well as distant metastases. Nevertheless, in controversial cases, it is necessary to perform a biopsy of the prostatic fossa or a biopsy of the prostate to assess the presence of a local recurrence under guidance of MRI or TRUS findings.
  
  
  CONCLUSIONS
  It is likely that imaging will be extensively used in the future to detect and localize prostate cancer local recurrences before salvage treatment.
authors.affiliation: Department of Emergency and Organ Transplantation-Urology I, University "Aldo Moro", Bari, Italy. martino@urologia.uniba.it
authors.forename: Pasquale
authors.initials: P
authors.lastname: Martino
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scattoni
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Galosi
authors.forename: Paolo
authors.initials: P
authors.lastname: Consonni
authors.forename: Carlo
authors.initials: C
authors.lastname: Trombetta
authors.forename: Silvano
authors.initials: S
authors.lastname: Palazzo
authors.forename: Carmen
authors.initials: C
authors.lastname: Maccagnano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Liguori
authors.forename: Massimo
authors.initials: M
authors.lastname: Valentino
authors.forename: Michele
authors.initials: M
authors.lastname: Battaglia
authors.forename: Libero
authors.initials: L
authors.lastname: Barozzi
mesh_terms: D001706:Biopsy; D017679:Cryotherapy; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D049268:Positron-Emission Tomography; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D018084:Ultrasonography, Interventional