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Objective: We describe the diagnostic procedure performed during the
workup of a patient with PSA failure after R1 prostatectomy focusing on
the prostate bed, pelvic lymph node and a suspicious bone lesion.
Materials and Methods: A patient with prostate cancer (pT3b pN1
(4/11) M0 G3) prostatectomy R1. The postoperative PSA value was
2.95ng/ml. The CT scans showed a suspect internal iliac lymph node and
an unclear osteolytic lesion in the left os ileum of the patient. For the
clarification of these lesion we performed a cholin-PET, a pelvic MRI
and a MDP-SPECT-CT.
Results: The pelvic MRI revealed a local recurrence in the prostate bed,
the other imaging modalities were false negative in this region on first
diagnosing. The MRI scan missed a left iliac lymph node which was
confirmed in the Cholin-PET-CT. Due to its small size the osteolytic
bone lesion could not be properly assessed with a state-of-the-art SPECT
or Cholin-PET-CT, with the MRI this lesion could be reasonably judged
as negative.
Conclusion: For complete staging in the postoperative setting for
prostate cancer the combination of several modalities may be necessary
to correctly stage the prostate bed, lymph node status and bone status. In
the presented case, MRI and CT scan alone the pelvic lymph node would
have been missed. Knowledge of the recurrence in the prostate bed,
lymph node status and bone metastasis is essential relevant for the
treatment decision.