What is considered a biochemical recurrence (BCR) after radical prostatectomy ?
Biochemical recurrence (BCR) is considered as a PSA level ≥ 0.4 ng/mL with a subsequent increase.
Which sequence (which has not been in conducted in this case) has been reported to provide more value in the detection of recurrent disease than in primary tumours?
Dynamic contrast enhancement (DCE).
Which sequences should be included in the protocol for assessment of recurrent prostate cancer?
Basically it can be done with a multi-parametric MRI protocol, including: T2w in three planes, DWI (with high b-value >1400), DCE and T1w of the whole pelvis.
Findings:
Status post-prostatectomy with a prostatectomy fossa.
- T2 inhomogeneously hyperintense nodular mass, markedly hyperintense on b1400 and markedly hypointense in ADC map around the prostatectomy margins of the vesicourethral anastomosis, especially on the right and less on the left posterolateral margin, also on the anterior inferior margin
- further suspicious nodular in T2 hyperintense finding in the bladder neck
Seminal vesicles: retained right seminal vesicle with no obvious tumour growth
Lymph nodes: three suspicious lymph nodes in the perirectal, presacral fatty tissue (up to 8mm size)
Impression:
Status post radical prostatectomy.
Local tumour recurrence at the vesicourethral anastomosis and bladder neck.
Pelvic lymph node metastases in the presacral perirectal fatty tissue.