Montefiore Medical Center, Bronx, NY
Nicola Joseph Nasser , Victoria Chernyak , Shalom Kalnicki , Jonathan Klein
Background: Radical prostatectomy (RP) is a common treatment modality for localized prostate cancer. Biochemical failure after RP is usually evaluated with whole body imaging to rule out metastatic disease and pelvic MRI to detect local recurrence in the prostate bed. We analyzed disease characteristics and demographic data of patients with rising PSA after RP to determine correlation with MRI-detected cancer recurrence. Methods: Using Clinical Looking Glass, an institutional data registry query tool, we identified all MRI scans performed at our institution between January 2013 and January 2018 to evaluate for the presence of prostate cancer after RP due to rising prostate specific antigen (PSA) levels. Using Chi-square testing, we analyzed PSA levels, pathologic disease characteristics, time from surgery to biochemical failure, and patient demographic characteristics as predictors of local recurrence detected by pelvic MRI. Results: We identified 64 patients who underwent MRI for rising PSA and had complete clinical and pathological data available. A prostate bed nodule compatible with local recurrence was found in 17 patients (27%). Thirty-six patients (56%) had no evidence of tumor in the prostate bed or pelvis. Eleven patients (17%) had a suspicious lesion which could represent scarring, retained seminal vesicle or recurrent cancer. Patient race was associated with likelihood of detecting a prostate nodule on MRI (p = 0.04) with African-American patients having 82% lower chance of MRI-detected tumor recurrence compared with White patients (p = 0.045). No other characteristic was significantly associated with MRI-detected recurrence including prostate cancer risk group, Gleason score, extra-capsular extension, positive surgical margin, seminal vesicle involvement, perineural invasion, lymphovascular invasion, and PSA level before MRI. Conclusions: African-American patients with biochemical failure after RP are less likely to have MRI-detectable recurrence in the prostate bed compared with white patients. This data may support a higher propensity toward microscopic metastatic disease at the time of biochemical failure in this population.
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