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MRI Finds Recurrences in Patients With Rising PSA Level

MRI Finds Recurrences in Patients With Rising PSA Level

ATLANTA—Dynamic magnetic resonance imaging (MRI) may be able to detect
recurrent prostate cancer after prostatectomy when the patient has a negative
biopsy but a rising prostate-specific antigen (PSA) level.

This could potentially spare the patient the need for a second or third
biopsy, said Miki Takeda, MD, a radiologist with Sapporo Medical University,
Japan. She presented the findings at the 102nd Annual Meeting of the American
Roentgen Ray Society (abstract 262).

According to Dr. Takeda, a rising PSA level following radical prostatectomy
nearly always means recurrence of cancer. "In our hospital, about 30% of
patients have rising PSA levels following radical prostatectomy," she
said.

To test the ability of MRI to predict local recurrence, Dr. Takeda and her
colleagues evaluated 21 patients with rising PSA levels who had undergone a
radical prostatectomy. They examined the prostatic fossa with T2-weighted
images. After a bolus injection of a gadolinium contrast agent, multisectional
dynamic MR images were obtained every 10 to 15 second for 90 seconds (see
Figure).

Although all patients had a negative ultrasound-guided biopsy, MRI suggested
local recurrence in 17 of the 21 patients. "In most cases, a second or
third biopsy would have been needed to confirm recurrence, and this takes time—time
in which the patient’s PSA level may continue to rise," Dr. Takeda said.

Successful Treatment

Fifteen of the 17 patients with suggested local recurrence were treated with
radiation therapy. PSA levels gradually declined in 10 of these patients after
a 1-year follow-up period, and 7 were subsequently considered cancer free.

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