Contemporary Mapping of Post-Prostatectomy Prostate Cancer Relapse with ¹¹C-Choline Positron Emission Tomography and Multiparametric Magnetic Resonance Imaging

Purpose We identify sites and patterns of cancer recurrence in patients with post-prostatectomy biochemical relapse using ¹¹C-choline positron emission tomography/computerized tomography and endorectal coil multiparametric magnetic resonance imaging. Materials and Methods 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. Results 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). Conclusions 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.