Prostate MR Imaging for Posttreatment Evaluation and Recurrence

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Key points

  • Multiparametric MR imaging (mpMRI) can help in evaluation of posttreatment changes after diagnosis and treatment of prostate cancer as well as for diagnosis of locally recurrent disease.

  • After radical prostatectomy, radiation therapy, or focal therapy, there are certain expected changes in the remaining tissue.

  • Many of the mpMRI patterns of recurrent disease are similar to those of primary prostate cancer. In diagnosis of recurrence, however, normal posttreatment changes and possible inflammation

Multiparametric MR imaging after radical prostatectomy

RP is a common active treatment chosen for PCa patients with localized disease, with approximately 40% of patients undergoing definitive therapy choosing this option.18 RP includes total removal of the prostate and seminal vesicles, along with pelvic lymph node dissection to varying extents for evaluation of local metastasis.19 Subsequent pathology analysis evaluates surgical margins and lymph nodes for staging. Risk for future BCR is a consideration at this point, because certain

Multiparametric MR imaging after radiation therapy

The second most common definitive treatment chosen for stages I to III PCa is RT, given to up to 40% of patients over 65 years old and up to 25% of patients under 65 years old.42 RT can be offered as EBRT or brachytherapy. EBRT is generally used for earlier-stage disease and may be offered in forms, such as intensity-modulated RT or stereotactic body RT. In this approach, all radiation is delivered externally and focused through beams to the prostate. In contrast, brachytherapy uses radioactive

Multiparametric MR imaging after focal therapy

Focal therapy is a newly emerging treatment option for patients with localized PCa that falls within a certain criteria that allows the index tumor to be directly targeted. Focal therapy relies on use of various energies for local destruction of cancer cells in the gland, such as microwave, focal laser ablation (FLA), cryotherapy, and HIFU. Regardless of which energy is used, there are numerous posttreatment changes seen on follow-up MR imaging that are important to consider for success of

Summary

Prostate mpMRI offers promising potential for visualization of posttreatment changes and for evaluation of local recurrent disease in the context of BCR. Because the mpMRI evaluation is so important in detection of localized recurrence, it is vital that radiologists be communicative with the multidisciplinary team. The referring urologist, radiation oncologist, or medical oncologist should be aware that the radiologist will be acquiring and interpreting a dedicated MR imaging for posttreatment

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