Hijazi S, Meller B, Leitsmann C, Strauss A, Meller J, Ritter C O, Lotz J, Schildhaus H-U, Trojan L, Sahlmann C O
Department of Urology, University Medical Center Goettingen, Goettingen, Germany.
Department of Nuclear Medicine, University Medical Center Goettingen, Goettingen, Germany.
Prostate. 2015 Dec;75(16):1934-40. doi: 10.1002/pros.23091. Epub 2015 Sep 10.
The first evaluation of pelvic extended lymph node dissection (pLND) in oligometastatic prostate cancer (PCa) detected by (68)Ga-PSMA PET/CT.
Retrospective analysis of 35 PCa patients underwent (68)Ga-PSMA PET/CT affected by biochemical recurrence (BCR) after curative treatment (n = 23) or before primary therapy of high-risk PCa (n = 12). We performed pLND associated with pathologic imaging in 17 men with nodal oligometastatic PCa.
Indicative lesions for PCa in PET/CT were detected in 91.4% (32 of 35) of patients. Nodal, bone, visceral (pulmonary), and within the prostate suspected disease were detected in 72% (23 of 32), 16% (5 of 32), 6% (2 of 32), and 47% (15 of 32) of patients, respectively. Median serum PSA in patients with pathological radiotracer uptake in recurrent and high-risk PCa patients was 2.9 ng/ml (range 0.18-30) and 19.5 ng/ml (range 6-90), respectively. The median number of removed lymph nodes with pLND in recurrent and high-risk PCa was 10 (range 4-17) and 12 (range 8-29) per patient and the median number of positive lymph nodes was 1 (range 1-2) and 3 (2-3) per patient, respectively. In total, two false positive and one false-negative lymph node were found. Diagnostic accuracies per nodal lesion in total of 213 removed nodes: sensitivity, 94%; specificity, 99%; positive predictive value (PPV), 89%, and negative predictive value (NPV), 99.5%. After pLND, 53% (9 of 17) of patients received androgen deprivation therapy and/or radiation therapy and hormonal therapy, while 47% (8 of 17) of patients remained free of any post-surgery therapy. Follow-up PSA remained less than 0.2 ng/ml in 82% (14 of 17) of patients. After pLND, immediate BCR (PSA never measured less than 0.2 ng/ml) in 18% (3 of 17) of patients was recorded.
This represents the first study of pLND in the setting of nodal oligometastatic PCa detected by (68)Ga-PSMA PET/CT. The use of (68)Ga-PSMA PET/CT could be to improve the accuracy for the detection of nodal micrometastases. These promising findings need validation in larger studies.
首次对通过（68）Ga-PSMA PET/CT检测出的寡转移前列腺癌（PCa）患者进行盆腔扩大淋巴结清扫术（pLND）评估。
回顾性分析35例PCa患者，其中23例为根治性治疗后发生生化复发（BCR），12例为高危PCa患者在接受初始治疗前，均接受了（68）Ga-PSMA PET/CT检查。我们对17例伴有淋巴结寡转移PCa的男性患者进行了与病理影像相关的pLND。
91.4%（35例中的32例）的患者在PET/CT中检测到PCa的指示性病变。分别有72%（32例中的23例）、16%（32例中的5例）、6%（32例中的2例）和47%（32例中的15例）的患者检测到淋巴结、骨、内脏（肺）和前列腺内疑似病变。复发和高危PCa患者中，病理放射性示踪剂摄取患者的血清PSA中位数分别为2.9 ng/ml（范围0.18 - 30）和19.5 ng/ml（范围6 - 90）。复发和高危PCa患者pLND切除的淋巴结中位数分别为每位患者10个（范围4 - 17）和12个（范围8 - 29），阳性淋巴结中位数分别为每位患者1个（范围
1 - 2）和3个（2 - 3）。总共发现2例假阳性和1例假阴性淋巴结。在总共213个切除的淋巴结中，每个淋巴结病变的诊断准确性：敏感性为94%；特异性为99%；阳性预测值（PPV）为89%，阴性预测值（NPV）为99.5%。pLND后，53%（17例中的9例）的患者接受了雄激素剥夺治疗和/或放射治疗以及激素治疗，而47%（17例中的8例）的患者术后未接受任何治疗。82%（17例中的14例）的患者随访PSA仍低于0.2 ng/ml。pLND后，18%（17例中的3例）的患者记录到即刻生化复发（PSA从未测量到低于0.2 ng/ml）。
这是首次对通过（68）Ga-PSMA PET/CT检测出的淋巴结寡转移PCa患者进行pLND的研究。使用（68）Ga-PSMA PET/CT可能会提高淋巴结微转移检测的准确性。这些有前景的发现需要在更大规模的研究中进行验证。
