Magnetic resonance imaging in the detection of local prostate cancer recurrence in patients with various PSA levels: a retrospective study

INTRODUCTION: Prostate cancer (PCa) is one of the most common cancer diseases. Approximately 30% of patients undergoing radical prostatectomy develop biochemical recurrence within the first 2 years after completion of treatment. One of the leading and available methods for diagnosing local recurrence of prostate cancer is multiparametric magnetic resonance imaging (mpMRI).

OBJECTIVE: To determine the effectiveness of mpMRI in detecting local recurrence of PCa in patients after radical prostatectomy (RP) with different levels of total prostate-specific antigen (tPSA).

MATERIALS AND METHODS: mpMRI of the pelvis was performed in 118 patients with biochemical relapse of PCa. The criteria for inclusion of patients in the retrospective study were the absence of previous radiation and hormonal therapy. Patients with positive surgical margins were excluded from the study. 46 patients were at low risk of PCa progression, 38 patients were at intermediate risk, and 34 patients were at high risk. Median obPSA 1.72 ng/ml (range 0.22 to 22.19 ng/ml). Median biochemical relapse 11 months. Patients were divided into groups depending on the level of obPSA (I group 0.2–0.5 ng/ml; II group 0.5–1.0 ng/ml; III group 1.0–3.0 ng/ml; IV group more than 3.0 ng/ml). Interpretation of the results was carried out according to the unified reporting system for assessing local recurrence of prostate cancer in patients after RP and RT — prostate imaging recurrence reporting (PI-RR). The probability of local recurrence of prostate cancer depending on the level of obPSA was analyzed using a statistical logistic regression model.

DISCUSSION: Early diagnosis of PCa recurrence includes the need to identify local or distant recurrence, determine its volume and precise localization. mpMRI is highly effective in patients with BCR after RP with a total PSA level of more than 1 ng/ml. With a lower PSA level, the percentage of local recurrence detection is lower, which may be due to the small size of the recurrent lesion. In patients with biochemical recurrence of PCa, when mpMRI data indicate a low or uncertain probability of recurrence (PI-RR 1, 2 and 3), PET/CT with 68Ga-PSMA is recommended to exclude distant and regional metastases, as well as as an additional diagnostic method for detecting local recurrence of PCa.

CONCLUSION: mpMRI is a highly effective diagnostic method for biochemical recurrence of prostate cancer, which allows for a personalized approach to further treatment. A significant relationship was found between the level of total PSA and the probability of detecting local recurrence according to mpMRI data. Local recurrence of prostate cancer is most often detected at a PSA level above 1 ng/ml, with a sensitivity of 91.8% and a specificity of 88.9%. With a lower value of total PSA, sensitivity and specificity decrease. With a recurrence focus value of ≥7.8 mm, local recurrence is confirmed in 90.4% of patients with subsequent histological examination.

1. Bray F., Laversanne M., Sung H. et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries // CA Cancer J. Clin. 2024. Vol. 74, No. 3. Р. 229–263. doi: 10.3322/caac.21834.

2. Shakhzadova A.O., Starinsky V.V., Lisichnikova I.V. Cancer care to the population of Russia in 2022. Siberian Journal of Oncology, 2023, Vol. 22, No. 5, рр. 5–13 (In Russ.). doi: 10.21294/1814-4861-2023-22-5-5-13.

3. Shikhzadaev M.Sh., Shkolnik M.I., Zharinov G.M. et al. Modern approaches in treatment for locally advanced prostate cancer. Oncology issues, 2018, Vol. 64, No. 4, рр. 478–484 (In Russ.). doi: 10.37469/0507-3758-2018-64-4-478-484.

4. Nosov D.A., Volkova M.I., Gladkov O.A. et al. Practical Guidelines for the treatment of prostate cancer. Malignant Tumors: Practice Guidelines RUSSCO. Рart 1, 2023, No. 3s2, рр. 640–660 (In Russ.)]. doi: 10.18027/2224-5057-2023-13-3s2-1-640-660.

5. Cornford P., Bellmunt J., Bolla M. et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part II: Treatment of Relapsing, Metastatic, and Castration-Resistant Prostate Cancer // Eur. Urol. 2017. Vol. 71, No. 4. Р. 630–642. doi: 10.1016/j.eururo.2016.08.002.

6. Hoeh B., Wenzel M., Hohenhorst L. et al. Anatomical Fundamentals and Current Surgical Knowledge of Prostate Anatomy Related to Functional and Oncological Outcomes for Robotic-Assisted Radical Prostatectomy // Front Surg. 2022. Vol. 8. Р. 825183. doi: 10.3389/fsurg.2021.825183.

7. Dolbov A.L., Stanzhevskii A.A., Maistrenko D.N. et al. Optimization of staging algorithm for newly detected prostate cancer by using PET/CT with 68Ga-PSMA: a retrospective study. Diagnostic radiology and radiotherapy, 2023. Vol. 13, No. 4, рр. 46–56 (In Russ.).

8. Krupina M.V., Trofimova T.N., Valkov M.Yu. Magnetic resonance picture of changes in the prostate gland in patients with localized prostate cancer after radical external beam radiotherapy. Diagnostic radiology and radiotherapy, 2021, Vol. 12, No. 2, рр. 79–91 (In Russ.)]. doi: 10.22328/2079-5343-2021-12-2-79-91.

9. Weinreb J.C., Barentsz J.O., Choyke P.L. et al. PI-RADS Prostate Imaging — Reporting and Data System: 2015, Version 2 // Eur. Urol. 2016. Vol. 69, No. 1. Р. 16– 40. doi: 10.1016/j.eururo.2015.08.052.

10. Panebianco V., Villeirs G., Weinreb J.C. et al. Prostate Magnetic Resonance Imaging for Local Recurrence Reporting (PI-RR): International Consensus — based Guidelines on Multiparametric Magnetic Resonance Imaging for Prostate Cancer Recurrence after Radiation Therapy and Radical Prostatectomy // Eur. Urol. Oncol. 2021. Vol. 4, No. 6. Р. 868–876. doi: 10.1016/j.euo.2021.01.003.

11. Zhang-Yin J., Montravers F., Montagne S., Hennequin C., Renard-Penna R. Diagnosis of early biochemical recurrence after radical prostatectomy or radiation therapy in patients with prostate cancer: State of the art // Diagn Interv Imaging. 2022. Vol. 103, No. 4. P. 191–199. doi:10.1016/j.diii.2022.02.005.

12. Notley M., Yu J., Fulcher A.S., Turner M.A. et al. Pictorial review. Diagnosis of recurrent prostate cancer and its mimics at multiparametric prostate MRI // Br. J. Radiol. 2015. Vol. 88, No. 10542. Р. 0150362. doi: 10.1259/bjr.20150362.

13. Froehner M., Koch R., Graefen M. Re: Mottet N., van den Bergh R.C.N., Briers Е. et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent // Eur. Urol. 2021. Vol. 79. Р. 243–262: Comorbidity Measurement in Patients with Prostate Cancer // Eur. Urol. 2021. Vol. 79, No. 5. e138. doi: 10.1016/j.eururo.2021.02.005.

14. King C.R. The timing of salvage radiotherapy after radical prostatectomy: a systematic review // Int. J. Radiat. Oncol. Biol. Phys. 2012. Vol. 84, No. 1. Р. 104–111. doi: 10.1016/j.ijrobp.2011.10.069.

15. Ciccarese F., Corcioni B., Bianchi L. et al. Clinical Application of the New Prostate Imaging for Recurrence Reporting (PI-RR) Score Proposed to Evaluate the Local Recurrence of Prostate Cancer after Radical Prostatectomy // Cancers (Basel). 2022. Vol. 14, No. 19. Р. 4725. Published 2022 Sep 28. doi: 10.3390/cancers14194725.

16. Bergaglio C., Giasotto V., Marcenaro M. et al. The Role of mpMRI in the Assessment of Prostate Cancer Recurrence Using the PI-RR System: Diagnostic Accuracy and Interobserver Agreement in Readers with Different Expertise // Diagnostics (Basel). 2023. Vol. 13, No. 3. Р. 387. Published 2023. Jan. 20. doi: 10.3390/diagnostics13030387.

17. Kitajima K., Hartman R.P., Froemming A.T., Hagen C.E., Takahashi N., Kawashima A. Detection of Local Recurrence of Prostate Cancer After Radical Prostatectomy Using Endorectal Coil MRI at 3 T: Addition of DWI and Dynamic Contrast Enhancement to T2-Weighted MRI // AJR Am. J. Roentgenol. 2015. Vol. 205, No. 4. Р. 807–816. doi: 10.2214/AJR.14.142.

18. Franco P.N., Frade-Santos S., García-Baizán A. et al. An MRI assessment of prostate cancer local recurrence using the PI-RR system: diagnostic accuracy, interobserver reliability among readers with variable experience, and correlation with PSA values // Eur. Radiol. 2024. Vol. 34, No. 3. Р. 1790–1803. doi: 10.1007/s00330-023-09949-7.

19. Meredith G., Wong D., Yaxley J. et al. The use of 68Ga-PSMA PET CT in men with biochemical recurrence after definitive treatment of acinar prostate cancer // BJU Int. 2016. Vol. 118, Suppl. 3. Р. 49–55. doi: 10.1111/bju.13616.

20. Kranzbühler B., Müller J., Becker A.S. et al. Detection Rate and Localization of Prostate Cancer Recurrence Using 68Ga-PSMA-11 PET/MRI in Patients with Low PSA Values ≤0,5 ng/m // J. Nucl. Med. 2020. Vol. 61, No. 2. Р. 194–201. doi: 10.2967/jnumed.118.225276.