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Diagnostic Performance of 1.5 Tesla Endorectal MR Imaging and MR Spectroscopic Imaging for the Detection of Locally Recurrent Prostate Cancer after External Beam Radiation Therapy

RESULTS: there was a statistically significant difference between the AZ for T2-weighted MR imaging (0.67; 95%CI=0.60-0.74%) and for the integrated approach (0.79, 95%CI=0.72-0.87) (figure 1). MR spectroscopic imaging had more true positive results when compared to T2-weighted MR imaging alone (58.7% versus 41.3%, respectively), without an important change in the number of false positive results (9.8% versus 7.3%, respectively). Fourteen hemi-prostates were incorrectly classified as negative by both techniques and the diagnosis of recurrent disease was missed in 8 patients. CONCLUSION: the addition of MR spectroscopic imaging to T2-weighted MR imaging significantly improves the detection of locally recurrent prostate cancer after external beam radiotherapy. The resulting information may assist the clinician to advise patients about subsequent evaluation, selecting those for whom targeted hemi-prostate biopsy is appropriate to confirm disease. Although targeted therapies may be offered to patients in whom very minimal recurrent disease is diagnosed, hemi-prostate imaging evaluation is sufficiently accurate to obviate the need for sextant localization, since the most commonly recommended salvage treatments (prostatectomy and LDR brachytherapy) treat the entire gland.