Diagnostic yield of multiparametric MRI for local recurrence at biochemical recurrence after radical prostatectomy

To validate the diagnostic yield of multiparametric magnetic resonance imaging (mpMRI) for local biochemical recurrence after radical prostatectomy in patients with biochemical recurrence using large consecutive patient data.

Of 4632 patients who underwent radical prostatectomy for prostate adenocarcinoma, 748 patients with prostate-specific antigen > 0.2 ng/mL and second confirmatory level were retrospectively identified. Among them, 468 patients who underwent multiparametric magnetic resonance imaging were analyzed. The primary outcome measure was the diagnostic yield of multiparametric magnetic resonance imaging for local recurrence, and the secondary measure was its accuracy, using the response to salvage radiotherapy as reference.

Only 33 patients (7.1%) showed positive imaging findings. The positive and negative predictive values were 84.8% (28/33) and 37.5% (45/120), respectively. The sensitivity and specificity were 27.2% (28/103) and 90% (45/50), respectively. The overall accuracy was 47.7% (73/153). In multivariate logistic regression analysis, prostate-specific antigen level at recurrence was found to be the only factor significantly higher in the positive image findings group.

The universal use of multiparametric magnetic resonance imaging resulted in a low-diagnostic yield for local recurrence in patients with biochemical recurrence after radical prostatectomy. The results suggest that selective use of multiparametric magnetic resonance imaging should be considered in patients with a higher prostate-specific antigen threshold.