Winter Alexander, Uphoff Jens, Henke Rolf-Peter, Wawroschek Friedhelm
Department of Urology and Paediatric Urology, Hospital Oldenburg, 26133 Oldenburg, Germany.
Adv Urol. 2012;2012:609612. doi: 10.1155/2012/609612. Epub 2011 Jun 26.
Introduction. To evaluate whether secondary resection of lymph node (LN) metastases (LNMs) can result in PSA remission, we analysed the PSA outcome after resection of LNM detected on PET/CT in patients with biochemical failure. Materials and Methods. 11 patients with PSA relapse (mean 3.02 ng/mL, range 0.5-9.55 ng/mL) after radical prostatectomy without adjuvant therapy were included. Suspicious LN (1-3) detected on choline PET/CT and nearby LN were openly dissected (09/04-02/11). The PSA development was examined. Histological and PET/CT findings were compared. Results. 9 of 10 patients with histologically confirmed LNM showed a PSA response. 4 of 9 patients with single LNM had a complete permanent PSA remission (mean followup 31.8, range 1-48 months). Of metastasis-suspicious LNs (14) 12 could be histologically confirmed. The additionally removed 25 LNs were all correctly negative. Conclusions. The complete PSA remissions after secondary resection of single LNM argue for a feasible therapeutic benefit without adjuvant therapy. For this purpose the choline PET/CT is in spite of its limitations currently the most reliable routinely available diagnostic tool.
引言。为了评估淋巴结转移（LNMs）的二次切除是否能导致前列腺特异性抗原（PSA）缓解，我们分析了生化复发患者在PET/CT上检测到的LNMs切除后的PSA结果。材料与方法。纳入11例根治性前列腺切除术后未接受辅助治疗且出现PSA复发（平均3.02 ng/mL，范围0.5 - 9.55 ng/mL）的患者。在胆碱PET/CT上检测到的可疑LN（1 - 3个）及附近LN进行开放性解剖（2009年4月至2011年2月）。检查PSA的变化情况。比较组织学和PET/CT结果。结果。10例组织学确诊为LNMs的患者中有9例出现PSA反应。9例单发LNMs患者中有4例实现了完全永久性PSA缓解（平均随访31.8个月，范围1 - 48个月）。14个可疑转移LN中，12个经组织学确诊。另外切除的25个LN均为阴性。结论。单发LNMs二次切除后实现的完全PSA缓解表明在无辅助治疗的情况下有可行的治疗益处。为此，尽管胆碱PET/CT有其局限性，但目前仍是最可靠的常规可用诊断工具。
