Title:The Dilemma of Localizing Disease Relapse After Radical Treatment for Prostate Cancer: Which is the Value of the Actual Imaging Techniques?
VOLUME: 6 ISSUE: 2
Author(s):Schiavina R, Ceci F, Borghesi M, Brunocilla E, Vagnoni V, Gacci M, Castellucci P, Nanni C, Martorana G and Fanti S
Affiliation:Service of Nuclear Medicine, Deprtment of Radiological and Histopathological Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy.
Keywords:Prostate cancer, PSA relapse, bon metastasis, lymph-node metastasis, local relapse, systemic relapse, PET/CT,
Choline, FACBC.
Abstract:Only few patients with PSA relapse after radical treatment will show clinically detectable disease. Although the
natural history of recurrent prostate cancer is often one of the slowly progressing diseases, in some men it can be rapid
and may need a salvage treatment. In general, time to PSA relapse, PSA velocity and PSA doubling time are useful in patient
assesment. In patients with PCa disease relapse after primary therapy, salvage treatment for a local recurrence should
only be offered to patients with little risk of already having metastases. In these patients a systemic imaging negative for
metastases is mandatory, a positive biopsy is not always necessary before radiotherapy, but is mandatory before salvage
prostatectomy. In patients with a high risk of distant metastases and suitable for systemic salvage therapy, a positive lesion
must be obviously visualized with one of the currently available imaging techniques. Transrectal ultrasound has low
accuracy in the detection of the recurrence. Multiparametric Magnetic Resonance Imaging may have a role in the early
phase of PSA relapse. Conventional imaging, such as bone scan and CT, are not suggested in the initial phase of BCR.
Today, it has been reported that PET/CT allows changing the therapeutic strategy (from palliative to curative treatment
and vice-versa) in about 20% of cases. In recent years, the new radiotracer 18F-FACBC has been proposed as a possible
alternative radiopharmaceutical to detect PCa relapse.
The aim of the present paper is to evaluate the management of patients with BCR after radical treatment of PCa from the
urologist point of view.
