Which imaging methods should be used prior to salvage radiotherapy after prostatectomy for prostate cancer?

Prostatectomy is one of the most widely used methods for treatment of adenocarcinoma of the prostate. According to anatomopathological criteria, between 10 and 40% of patients will display biochemical relapse in the absence of adjuvant radiotherapy. Anatomopathological and biochemical criteria are powerful tools for selecting patients for salvage radiotherapy. The aim of this article is to review literature on the latest progress in radiological and nuclear medicine techniques and their performance levels, in order to determine local, regional and metastatic relapses associated with the techniques and specify the radiotherapy target volume. Magnetic resonance imaging (MRI) displays the best sensitivity and specificity for examination of the prostate bed and enables simultaneous assessment of the pelvic region - thus diminishing the utility of computed tomography. The performance levels of MRI will probably continue to improve, with the use of dynamic MRI and MR spectroscopy. Despite the development of new markers like C-11 and F-18 choline and acetate, the sensitivity of positron emission tomography is still low. Prospective studies with an appropriate methodology are necessary for specifying the technique's value in this context. (C) 2009 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.