前列腺癌局部治疗后高危生化复发的PSMA PET/CT表现

IF 1.6 Q3 UROLOGY & NEPHROLOGY
BJUI compass Pub Date : 2025-05-12 DOI:10.1002/bco2.70028
Nicole Handa, Richard Bennett IV, Eric V. Li, Austin Ho, Mitchell M. Huang, Sai Kumar, Clayton Neill, Ridwan Alam, Hiten D. Patel, Edward M. Schaeffer, Ashley E. Ross
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引用次数: 0

摘要

目的探讨高危BCR患者的PSMA PET/CT特征。本研究回顾性分析了2021年7月至2023年3月期间接受PET/CT检查的高危BCR前列腺癌(放疗后PSA≥2 ng/ml或根治性前列腺切除术后PSA≥1 ng/ml +/−RT)患者。排除既往有细胞毒性化疗、在PET/CT前3个月或PET/CT后3个月内开始进行雄激素剥夺治疗(ADT)或常规影像学阳性的患者。允许在≥9个月前完成新辅助/辅助ADT。采用Logistic回归、Pearson卡方检验、Wilcoxon秩和检验和Fisher精确检验进行分析。结果145例患者中有113例(77%)在PSMA PET/CT上有≥1个病变。PSMA PET/CT阳性在年龄、种族、初始活检Gleason分级或PSA上没有差异。总体而言,29例(20%)患者仅在前列腺/前列腺床有病变,31例(21%)患者有与N1M0疾病一致的病变,53例(37%)患者有与M1疾病一致的病变。对于M1患者,21/53(40%)有少转移性疾病(1-3个病变),32/53(60%)有更高的负担(3个病变)。RT组局部复发多见,RP组淋巴结复发多见,初始治疗时远处转移无差异。结论近80%的高危BCR患者在接受RP和/或RT前列腺癌局部治疗后,PSMA PET/CT显示阳性。除了强化的全身治疗外,高达55%的患者可能受益于补救性局部治疗、淋巴结盆腔放疗或针对低转移性疾病的转移性定向治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

PSMA PET/CT findings in high-risk biochemical recurrence after local treatment of prostate cancer

PSMA PET/CT findings in high-risk biochemical recurrence after local treatment of prostate cancer

Objectives

To describe PSMA PET/CT characteristics of patients with high-risk BCR.

Subjects/patients and methods

This was a retrospective analysis of patients with high-risk BCR prostate cancer (PSA ≥ 2 ng/ml above nadir after radiation therapy [RT] or ≥1 ng/ml after radical prostatectomy [RP] +/− RT) who underwent PET/CT from July 2021–March 2023. Patients with prior cytotoxic chemotherapy, androgen deprivation therapy (ADT) initiated >3 months prior to PET/CT or positive conventional imaging within 3 months of PET/CT were excluded. Neoadjuvant/adjuvant ADT completed ≥9 months prior was allowed. Logistic regression, Pearson's Chi-squared, Wilcoxon rank sum and Fisher's exact tests were used for analysis.

Results

A total of 113 of 145 (77%) included patients in the analysis had ≥1 lesion on PSMA PET/CT. There was no difference in PSMA PET/CT positivity based on age, race, Gleason Grade at initial biopsy or PSA. Overall, 29 (20%) patients had lesions in the prostate/prostate bed only, 31 (21%) had lesions consistent with N1M0 disease and 53 (37%) had lesions consistent with M1 disease. For M1 patients, 21/53 (40%) had oligometastatic disease (1–3 lesions), and 32/53 (60%) had a higher burden (>3 lesions). Local recurrence was more common with RT and nodal recurrence with RP, with no difference in distant metastasis by initial treatment.

Conclusion

Nearly 80% of patients with high-risk BCR after local treatment for prostate cancer with RP and/or RT will have positive findings on PSMA PET/CT. In addition to intensified systemic therapy, up to 55% of the patients may have benefitted from salvage local therapy, nodal pelvic radiation or metastasis-directed therapies for oligometastatic disease.

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CiteScore
2.30
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