title: Localizing sites of disease in patients with rising serum prostate-specific antigen up to 1ng/ml following prostatectomy: How much information can conventional imaging provide?
abstract: Accurate identification of the source of a detectable serum prostate-specific antigen (PSA) in the postprostatectomy setting is a major challenge among the urologic community. The aim of this study was to assess positivity rates of imaging examinations performed in patients with early PSA rise after prostatectomy and to summarize the management strategies adopted in this clinical scenario.
  
  
  
  Institutional Review Board-approved retrospective study of 142 postprostatectomy patients with PSA rise up to 1ng/ml who underwent evaluation with combination of multiparametric pelvic magnetic resonance imaging (MRI)±whole-body or bone MRI, bone scintigraphy, computed tomography (CT) chest-abdomen-pelvis,18F-fludeoxyglucose-positron emission tomography (PET)/CT or18F-sodium fluoride-PET/CT at a single tertiary cancer center. Imaging results were summarized per modality and compared with pathology findings.
  
  
  
  Pelvic MRI was positive in 15/142 (11%) patients (14 patients with local recurrence in the surgical bed and 1 patient with pelvic osseous metastases). Of these 15, 10 patients underwent additional imaging examinations; none revealed positive findings. Of the 127 patients with negative pelvic MRI, 54 (43%) underwent additional imaging examinations; only 1/54 had positive findings (false-positive T8 lesion on bone scintigraphy and FDG-PET/CT; biopsy was negative for cancer). Overall, 12/16 patients with positive imaging findings and 75/126 (60%) patients with negative imaging received treatment (radiation, hormones or chemotherapy).
  
  
  
  The conventional imaging identified sites of disease, almost always in the form of local recurrence, in a minority of patients with early PSA rise postprostatectomy.
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: vargasah@mskcc.org.
authors.forename: Hebert Alberto
authors.initials: HA
authors.lastname: Vargas
authors.affiliation: Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Alexandre G
authors.initials: AG
authors.lastname: Martin-Malburet
authors.affiliation: Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Takeda
authors.affiliation: Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Renato B
authors.initials: RB
authors.lastname: Corradi
authors.affiliation: Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: James
authors.initials: J
authors.lastname: Eastham
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wibmer
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Evis
authors.initials: E
authors.lastname: Sala
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Weber
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Hedvig
authors.initials: H
authors.lastname: Hricak
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D003131:Combined Modality Therapy; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D000072078:Positron Emission Tomography Computed Tomography; D049268:Positron-Emission Tomography; D011184:Postoperative Period; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D016879:Salvage Therapy; D012969:Sodium Fluoride; D059039:Standard of Care
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D012969:Sodium Fluoride; D017430:Prostate-Specific Antigen; C000615276:Fluorine-18
keywords: Bone scan; CT; MRI; PET; Prostate cancer; Recurrence