title: Contemporary Mapping of Post-Prostatectomy Prostate Cancer Relapse with11C-Choline Positron Emission Tomography and Multiparametric Magnetic Resonance Imaging.
abstract: We identify sites and patterns of cancer recurrence in patients with post-prostatectomy biochemical relapse using11C-choline positron emission tomography/computerized tomography and endorectal coil multiparametric magnetic resonance imaging.
  
  
  
  Between January 2008 and June 2015, 2,466 men underwent choline positron emission tomography for suspected prostate cancer relapse at our institution. Of these men 202 did not receive hormone or radiation therapy, underwent imaging with choline positron emission tomography and multiparametric magnetic resonance imaging, and were found to have disease recurrence. Overall patterns of recurrence were described, and factors associated with local only recurrence were evaluated using univariable and multivariable logistic regression.
  
  
  
  Median prostate specific antigen at positive scan was 2.3 ng/ml (IQR 1.4-5.5) with a median time from prostate specific antigen relapse to lesion visualization of 15 months (IQR 4.8-34.2). Of these 202 men 68 (33%) exhibited local only, 45 (22%) local plus metastatic and 89 (45%) metastatic only relapse. Pelvic node only relapse was observed in 39 (19%) men. Median prostate specific antigen at positive imaging for patients with local only, metastatic only and local plus metastatic relapse was 2.3, 2.7 and 2.2 ng/ml (p=0.46), with a median interval from biochemical recurrence to positive scan of 33.5, 7.0 and 15.0 months, respectively (p <0.001). On multivariable analysis time from biochemical recurrence to positive imaging was independently associated with local only recurrence (OR 1.10 for every 6-month increase, p=0.012).
  
  
  
  Combined choline positron emission tomography and multiparametric magnetic resonance imaging evaluation of biochemical recurrence after prostatectomy reveals an anatomically diverse pattern of recurrence. These findings have implications for optimizing the salvage treatment of patients with prostate cancer with relapse following surgery.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ilya
authors.initials: I
authors.lastname: Sobol
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Harras B
authors.initials: HB
authors.lastname: Zaid
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rimki
authors.initials: R
authors.lastname: Haloi
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lance A
authors.initials: LA
authors.lastname: Mynderse
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Adam T
authors.initials: AT
authors.lastname: Froemming
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Val J
authors.initials: VJ
authors.lastname: Lowe
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Davis
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Eugene D
authors.initials: ED
authors.lastname: Kwon
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota.
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Karnes
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000704:Analysis of Variance; D001707:Biopsy, Needle; D002250:Carbon Radioisotopes; D002794:Choline; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy / Q000379:methods; D016019:Survival Analysis
chemical_list: D002250:Carbon Radioisotopes; D002794:Choline
keywords: magnetic resonance imaging; prostatic neoplasms; radiotherapy; recurrence; salvage therapy