Open Access

ARTICLE

Early localization of recurrent prostate cancer after prostatectomy by endorectal coil magnetic resonance imaging

Brian J. Linder¹, Akira Kawashima², David A. Woodrum², Matthew K. Tollefson¹, R. Jeffrey Karnes¹, Brian J. Davis³, Laureano J. Rangel⁴, Bernard F. King², Lance A. Mynderse¹

1 Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
2 Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
3 Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
4 Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
Address correspondence to Dr. Lance A. Mynderse, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA

Canadian Journal of Urology 2014, 21(3), 7283-7289.

Abstract

Introduction: To evaluate the ability of endorectal coil (e-coil) magnetic resonance imaging (MRI) to identify early prostatic fossa recurrence after radical prostatectomy.
Materials and methods: We identified 187 patients from 2005–2011 who underwent e-coil MRI with dynamic gadolinium-contrast enhancement followed by transrectal ultrasound (TRUS) guided prostatic fossa biopsy for possible local prostate cancer recurrence. For analysis, local recurrence was defined as a negative evaluation for distant metastatic disease with a positive prostatic fossa biopsy, decreased prostate-specific antigen (PSA) following salvage radiation therapy, or increased lesion size on serial imaging.
Results: Local recurrence was identified in 132 patients, with 124 (94%) detected on e-coil MRI. The median PSA was 0.59 ng/mL (range < 0.1–13.1), and median lesion size on MRI was 1 cm. The sensitivity of MRI was 91%, with a specificity of 45%. The positive predictive value was 85%, with a negative predictive value of 60%. For patients with a PSA < 0.4 ng/mL the sensitivity of e-coil MRI was 86%. When a lesion was identified on MRI, the positive biopsy rate was 65% and lesion size was a significant predictor of positive biopsies. The positive biopsy rates were 51%, 74%, and 88% when the lesion was < 1 cm, 1 cm–2 cm, or > 2 cm, respectively (p = 0.0006).
Conclusions: E-coil MRI has a high level of sensitivity in identifying local recurrence of prostate cancer following radical prostatectomy, even at low PSA levels. E-coil MRI should be considered as the first imaging evaluation for biochemical recurrence for identifying patients suitable for localized salvage therapy.

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