Is there a role of PSMA-PET in focal therapy planning and follow-up?

IF 5.1 2区医学 Q1 ONCOLOGY

Prostate Cancer and Prostatic Diseases Pub Date : 2025-02-13 DOI:10.1038/s41391-025-00944-1

Rossella Nicoletti, Andrea Alberti, Vineet Gauhar, Elena Ciaralli, Chi Hang Yee, Peter Chiu, David Leung, Daniele Castellani, Theodoros Tokas, Bhaskar Somani, Francesco Sessa, Dmitry Enikeev, Nikhil Vasdev, Sergio Serni, Riccardo Campi, Mauro Gacci, Antony Chi Fai Ng, Jeremy Yuen Chun Teoh

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引用次数: 0

Abstract

Introduction: Focal therapy (FT) is a promising alternative to radical treatments for localized Prostate Cancer (PCa) in selected patients. However, it is not yet considered a standard treatment option, and there is currently no consensus on managing patients after FT. In this context, Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA-PET) may support multiparametric MRI (mpMRI) for both pre-operative planning and follow-up. The aim of this systematic review was to provide a comprehensive overview of the current applications of PSMA-PET in the field of FT and to analyze its future perspectives.

Evidence acquisition: A literature search was performed using PubMed and Scopus databases, following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement recommendations. All studies reporting data on PSMA-PET performed before and/or after FT for PCa were included. A narrative synthesis was employed to summarize the review findings. No quantitative synthesis was performed due to the heterogeneity and limitations of the studies.

Evidence synthesis: Seven studies (2 case reports, 1 retrospective, and 4 prospective single-center studies) were included in this review. A moderate-severe risk of bias was assessed for the included studies. In the field of FT, PSMA-PET showed promising but yet not validated results with several possible applications: (1) pre-operative planning and staging, aiming to improve patient selection trough the identification of intraprostatic suspected lesions and more accurate local and systemic staging; (2) guidance for biopsy and Region of Interest (ROI) definition; (3) follow-up imaging tool, aiming to decrease the number of unnecessary surveillance biopsies.

Conclusions: Limited evidence exists regarding the use of PSMA-PET in the field of FT, considering pre-operative setting, treatment guidance and its use as a non-invasive tool to evaluate treatment success or failure and for follow-up. In this scenario, even if the current evidence is still limited and inconclusive, PSMA-PET showed promising results with several possible applications.

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PSMA-PET在局灶治疗计划和随访中是否有作用？

局部治疗（FT）是一种有前途的替代根治性治疗局限性前列腺癌（PCa）在选定的患者。然而，它还没有被认为是一种标准的治疗选择，目前对FT后患者的管理也没有共识。在这种情况下，前列腺特异性膜抗原正电子发射断层扫描（PSMA-PET）可以支持多参数MRI （mpMRI）进行术前计划和随访。本系统综述的目的是全面概述PSMA-PET在FT领域的应用现状，并分析其未来前景。证据获取：使用PubMed和Scopus数据库进行文献检索，遵循系统评价和荟萃分析首选报告项目（PRISMA）声明建议。所有报告前列腺癌术前或术后PSMA-PET数据的研究均被纳入。采用叙述综合法总结综述结果。由于研究的异质性和局限性，没有进行定量综合。证据综合：本综述纳入了7项研究（2项病例报告、1项回顾性研究和4项前瞻性单中心研究）。纳入研究的偏倚风险为中度至重度。在FT领域，PSMA-PET显示出了有希望但尚未得到验证的结果，有几个可能的应用：(1)术前计划和分期，旨在通过识别前列腺内可疑病变和更准确的局部和全身分期来改善患者选择；(2)活检和感兴趣区域（ROI）定义指南；(3)随访成像工具，旨在减少不必要的监测活检次数。结论：考虑到术前设置、治疗指导以及将PSMA-PET作为评估治疗成败和随访的非侵入性工具，关于在FT领域使用PSMA-PET的证据有限。在这种情况下，即使目前的证据仍然有限和不确定，PSMA-PET在几种可能的应用中显示出有希望的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学

CiteScore

10.00

自引率

6.20%

发文量

142

审稿时长

6-12 weeks

期刊介绍： Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.