Clinical value of a negative [18F]F-PSMA PET/CT study in patients diagnosed with prostate cancer treated with prostatectomy with PSA rising below 1 ng/mL after radical prostatectomy, on the outcome of salvage radiotherapy

Revista espanola de medicina nuclear e imagen molecular Pub Date : 2025-03-01 DOI:10.1016/j.remnie.2025.500071

M. Cózar Santiago , J. García Garzón , A. Esteban Hurtado , J. Pastor Peiro , J. Ferrer Rebolleda

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引用次数: 0

Abstract

Objective

To assess the clinical value of [¹⁸F]F-PSMA negative PET/CT, in patients diagnosed with prostate cancer treated with prostatectomy with elevated PSA less than 1 ng/mL, on the outcome of salvage radiotherapy.

Method

We prospectively included 98 patients diagnosed with prostate cancer treated with prostatectomy with biochemical recurrence [mean PSA 0.51 ng/mL (range 0.17–1.0 ng/mL)] who were referred for an [¹⁸F]F-PSMA -PET/CT study.

The [¹⁸F]F-PSMA -PET/CT scan was negative in 53/98 patients (54.09%). Differences were analysed between those patients who were or were not candidates for pelvic salvage radiotherapy (PSRT) decided upon multidisciplinary committee and patient consent, with a minimum follow-up time for 1 year. Response to treatment was defined as a 50% reduction in PSA levels. Recurrence was ascertained upon clinical, analytical and imaging follow-up outcomes.

Results

54.7% (29/53) of the patients with a negative [¹⁸F]F-PSMA -PET/CT underwent PSRT.

Of these, 93.1% (27/29) patients demonstrated response to treatment (PSMA false negatives).

The remaining two patients showed fluctuating PSA levels without detecting disease on the [¹⁸F]F-PSMA -PET/CT follow-up study.

45.3% (24/53) of patients with negative [¹⁸F]F-PSMA -PET/CT did not undergo PSRT.

Of these, progressive PSA elevation was observed in 62.5% (15/24) (PSMA false negatives), localising recurrence on the [¹⁸F]F-PSMA -PET/CT follow-up study in 4 patients.

The remaining 9 patients (37.5%) showed fluctuating PSA levels without detecting disease on the [¹⁸F]F-PSMA -PET/CT follow-up study.

Our series confirmed 42 (42.85%) [¹⁸F]F-PSMA -PET/CT false negatives cases.

Conclusion

Patients diagnosed with prostate cancer with post-prostatectomy biochemical recurrence and a negative [¹⁸F]F-PSMA -PET/CT study are likely to benefit from pelvic salvage radiotherapy, with response seen in 93.1% of our cases.

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前列腺癌根治性前列腺切除术后PSA低于1 ng/mL诊断为前列腺癌患者的F-PSMA PET/CT阴性研究对补救性放疗预后的临床价值[18F]。

目的：探讨[18F]F-PSMA阴性PET/CT对前列腺癌行前列腺切除术且PSA升高小于1 ng/mL患者补救性放疗预后的临床价值。方法：我们前瞻性地纳入98例诊断为前列腺癌并行前列腺切除术并生化复发的患者[平均PSA 0.51 ng/mL（范围0.17-1.0 ng/mL）]，并转介进行[18F]F-PSMA -PET/CT研究。[18F]F-PSMA -PET/CT扫描阴性53/98例（54.09%）。经多学科委员会和患者同意决定是否接受盆腔保留放疗（PSRT）的患者之间进行差异分析，随访时间至少为1年。对治疗的反应被定义为PSA水平降低50%。根据临床、分析和影像学随访结果确定复发。结果：54.7%（29/53）的[18F]F-PSMA -PET/CT阴性患者行PSRT。其中，93.1%（27/29）患者表现出对治疗的反应（PSMA假阴性）。其余2例患者在[18F]F-PSMA -PET/CT随访研究中显示PSA水平波动，但未发现疾病。45.3%（24/53）的F-PSMA -PET/CT阴性[18F]患者未行PSRT。其中，62.5%（15/24）的患者出现进行性PSA升高（PSMA假阴性），4例患者在[18F]F-PSMA -PET/CT随访研究中定位复发。其余9例（37.5%）患者在[18F]F-PSMA -PET/CT随访研究中显示PSA水平波动，但未发现疾病。我们确认了42例（42.85%）[18F]F-PSMA -PET/CT假阴性病例。结论：诊断为前列腺癌的前列腺切除术后生化复发且F-PSMA -PET/CT阴性的患者可能受益于盆腔补救性放疗，93.1%的病例有反应。

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