Discrimination of local recurrence after radical prostatectomy: value of diffusion-weighted magnetic resonance imaging.

Background: Multiparametric magnetic resonance is the most accurate imaging technique for prostate cancer detection, staging, localization, and aggressiveness evaluation. We assessed accuracy of diffusion-weighted imaging in local recurrence diagnosis after radical prostatectomy.

Materials and methods: A retrospective study was conducted in 118 patients with findings suggestive of local recurrence in dynamic contrast-enhanced-magnetic resonance imaging. Local recurrence was defined clinically as a rising prostate-specific antigen level (biochemical recurrence) without radiographic evidence of distant metastasis over 6 months after surgery. Eighty-four patients (71.2%) had local recurrence (group 1) and 34 (28.8%) showed no recurrence (group 2). The diagnostic accuracy of diffusion-weighted imaging was assessed, and factors associated with local recurrence were evaluated using multivariate logistic regression analysis. Additional accuracy analysis was carried out according to the size of the nodule.

Results: In post-operative findings, group 1 patients had significantly higher serum prostate-specific antigen ( P  = 0.001), larger enhancing nodules ( P  = 0.005), and more positive findings in diffusion-weighted imaging ( P  = 0.001) than group 2 patients. The sensitivity of diffusion-weighted imaging was significantly higher for nodules ≥1 cm than for all nodules (96.6 vs. 80.9%, P  = 0.001), whereas the specificities were equivalent (100.0 vs. 97.1, P  = 0.529). In multivariate analysis, a positive finding in diffusion-weighted imaging was the independent predictor of local recurrence ( P  = 0.005), along with pathologic T stage ( P  = 0.018).

Conclusions: Diffusion-weighted imaging is accurate in distinguishing recurrence from enhancing nodule on dynamic contrast-enhanced-magnetic resonance. Nodules showing decreased diffusion suggest local recurrence, especially if sized ≥1 cm.