Université de Lyon, Lyon, 69003, France.
Eur Radiol. 2010 May;20(5):1254-66. doi: 10.1007/s00330-009-1647-4. Epub 2009 Nov 17.
Because prostate cancer local recurrences can be efficiently treated by salvage therapies, it becomes critical to detect them early.
The first alert is the rise of the prostate specific antigen (PSA) level after the post-treatment nadir, which can correspond to a distant recurrence, a local recurrence or both. This so-called biochemical failure (BF) is defined as PSA level > 0.2 ng/ml after radical prostatectomy (RP) and PSA level > nadir + 2 ng/ml after radiotherapy. There is no consensual definition of BF after cryotherapy, high-intensity focused ultrasound (HIFU) ablation or brachytherapy.
Local recurrences after RP are treated by radiotherapy, those after radiotherapy by RP, cryotherapy, brachytherapy or HIFU ablation. Recurrences after cryotherapy or HIFU ablation can be treated by a second session or radiotherapy. Recurrences after brachytherapy are difficult to treat. In patients with BF, MRI can detect local recurrences, whatever the initial treatment was. Dynamic contrast-enhanced MRI seems particularly accurate. The role of spectroscopy remains controversial. Ultrasound-based techniques are less accurate, but this may change with the advent of ultrasonic contrast media.
These recent advances in imaging may improve the outcome of salvage therapies (by improving patient selection and treatment targeting) and should open the way to focal salvage treatments in the near future.
由于前列腺癌局部复发可以通过挽救治疗有效地治疗，因此早期发现它们变得至关重要。
第一个警报是治疗后最低点后前列腺特异性抗原（PSA）水平的升高，这可能对应于远处复发、局部复发或两者兼有。这种所谓的生化失败（BF）定义为根治性前列腺切除术（RP）后 PSA 水平>0.2ng/ml 和放疗后 PSA 水平>最低点+2ng/ml。冷冻治疗、高强度聚焦超声（HIFU）消融或近距离治疗后 BF 尚无共识定义。
RP 后的局部复发通过放疗治疗，放疗后的局部复发通过 RP、冷冻治疗、近距离治疗或 HIFU 消融治疗。冷冻治疗或 HIFU 消融后的复发可以通过第二次治疗或放疗治疗。近距离治疗后的复发很难治疗。在 BF 患者中，无论初始治疗如何，MRI 都可以检测到局部复发。动态对比增强 MRI 似乎特别准确。光谱学的作用仍存在争议。基于超声的技术不太准确，但随着超声对比剂的出现，这种情况可能会改变。
这些影像学的最新进展可能会改善挽救治疗的结果（通过改善患者选择和治疗靶向），并有望在不久的将来为局部挽救治疗开辟道路。
