Nasser Nicola J, Chernyak Victoria, Shankar Viswanathan, Garg Madhur, Bodner William, Kalnicki Shalom, Klein Jonathan
Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, United States.
Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, United States.
Can Urol Assoc J. 2021 Jan;15(1):E22-E28. doi: 10.5489/cuaj.6463.
Radical prostatectomy (RP) is a standard treatment modality for localized prostate cancer. Biochemical failure after RP is usually evaluated with whole-body imaging to exclude distant metastatic disease, and pelvic magnetic resonance imaging (MRI) to detect local recurrence in the prostatectomy bed. The goal of this study is to correlate disease characteristics and demographic data in patients with rising prostate-specific antigen (PSA) after RP to determine association with MRI-detected cancer recurrence.
Sixty-four patients who underwent pelvic MRI for rising PSA after RP and had complete clinical and pathological data available were included. Using Chi-squared testing, we analyzed PSA levels, pathological disease characteristics (prostate cancer risk group, Gleason score, extracapsular extension, positive surgical margin, seminal vesicle involvement, perineural invasion, lymphovascular invasion, and PSA level before MRI), time from surgery to biochemical failure, and patient demographic characteristics as potential predictors of MRI-detected local recurrence.
Definite MRI-detected local recurrence was observed in 17/64 patients (27%). Eleven (17%) patients had a suspicious lesion with the differential of scarring, retained seminal vesicle, or recurrent cancer. Thirty-six (56%) patients had no evidence of tumor in the prostate bed or pelvis on MRI. Patient race was associated with likelihood of detecting a prostate nodule on MRI (p=0.04), with African American patients having 82% lower odds of MRI-detected tumor recurrence compared with white patients (p=0.045). No other tumor or patient characteristic was significantly associated with MRI-detected recurrence.
African American patients with biochemical failure after RP are less likely to have MRI-detectable recurrence in the prostate bed compared with white patients.
根治性前列腺切除术（RP）是局限性前列腺癌的标准治疗方式。RP术后的生化复发通常通过全身成像来评估以排除远处转移疾病，并通过盆腔磁共振成像（MRI）来检测前列腺切除床的局部复发。本研究的目的是将RP后前列腺特异性抗原（PSA）升高患者的疾病特征与人口统计学数据相关联，以确定与MRI检测到的癌症复发的相关性。
纳入64例RP后因PSA升高接受盆腔MRI检查且有完整临床和病理数据的患者。我们使用卡方检验分析了PSA水平、病理疾病特征（前列腺癌风险组、Gleason评分、包膜外侵犯、手术切缘阳性、精囊受累、神经周围侵犯、淋巴管侵犯以及MRI前的PSA水平）、从手术到生化复发的时间以及患者人口统计学特征，作为MRI检测到的局部复发的潜在预测因素。
64例患者中有17例（27%）经MRI明确检测到局部复发。11例（17%）患者有可疑病变，鉴别诊断为瘢痕、残留精囊或复发性癌症。36例（56%）患者的MRI显示前列腺床或盆腔无肿瘤证据。患者种族与MRI检测到前列腺结节的可能性相关（p = 0.04），与白人患者相比，非裔美国患者MRI检测到肿瘤复发的几率低82%（p = 0.045）。没有其他肿瘤或患者特征与MRI检测到的复发显著相关。
与白人患者相比，RP后生化复发的非裔美国患者在前列腺床发生MRI可检测到的复发的可能性较小。
