Department of Urology, Mayo Clinic, Rochester, Minnesota.
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
J Urol. 2017 Jan;197(1):129-134. doi: 10.1016/j.juro.2016.07.073. Epub 2016 Jul 20.
We identify sites and patterns of cancer recurrence in patients with post-prostatectomy biochemical relapse using C-choline positron emission tomography/computerized tomography and endorectal coil multiparametric magnetic resonance imaging.
Between January 2008 and June 2015, 2,466 men underwent choline positron emission tomography for suspected prostate cancer relapse at our institution. Of these men 202 did not receive hormone or radiation therapy, underwent imaging with choline positron emission tomography and multiparametric magnetic resonance imaging, and were found to have disease recurrence. Overall patterns of recurrence were described, and factors associated with local only recurrence were evaluated using univariable and multivariable logistic regression.
Median prostate specific antigen at positive scan was 2.3 ng/ml (IQR 1.4-5.5) with a median time from prostate specific antigen relapse to lesion visualization of 15 months (IQR 4.8-34.2). Of these 202 men 68 (33%) exhibited local only, 45 (22%) local plus metastatic and 89 (45%) metastatic only relapse. Pelvic node only relapse was observed in 39 (19%) men. Median prostate specific antigen at positive imaging for patients with local only, metastatic only and local plus metastatic relapse was 2.3, 2.7 and 2.2 ng/ml (p=0.46), with a median interval from biochemical recurrence to positive scan of 33.5, 7.0 and 15.0 months, respectively (p <0.001). On multivariable analysis time from biochemical recurrence to positive imaging was independently associated with local only recurrence (OR 1.10 for every 6-month increase, p=0.012).
Combined choline positron emission tomography and multiparametric magnetic resonance imaging evaluation of biochemical recurrence after prostatectomy reveals an anatomically diverse pattern of recurrence. These findings have implications for optimizing the salvage treatment of patients with prostate cancer with relapse following surgery.
我们通过使用 C-胆碱正电子发射断层扫描/计算机断层扫描和直肠内线圈多参数磁共振成像，确定前列腺癌根治术后生化复发患者的癌症复发部位和模式。
2008 年 1 月至 2015 年 6 月期间，共有 2466 名男性在我院因疑似前列腺癌复发而接受胆碱正电子发射断层扫描检查。其中 202 名男性未接受激素或放射治疗，接受了胆碱正电子发射断层扫描和多参数磁共振成像检查，结果发现有疾病复发。我们描述了总体复发模式，并使用单变量和多变量逻辑回归评估了与局部复发相关的因素。
阳性扫描时中位前列腺特异性抗原为 2.3ng/ml（IQR 1.4-5.5），从前列腺特异性抗原复发到病变显影的中位时间为 15 个月（IQR 4.8-34.2）。在这 202 名男性中，68 名（33%）表现为局部复发，45 名（22%）为局部加远处转移复发，89 名（45%）为远处转移复发。39 名（19%）男性出现盆腔淋巴结单独复发。局部仅复发、远处转移仅复发和局部加远处转移复发患者阳性影像学时的中位前列腺特异性抗原分别为 2.3、2.7 和 2.2ng/ml（p=0.46），从生化复发到阳性扫描的中位间隔分别为 33.5、7.0 和 15.0 个月（p<0.001）。多变量分析显示，从生化复发到阳性扫描的时间与局部复发独立相关（每增加 6 个月，OR 1.10，p=0.012）。
前列腺癌根治术后生化复发的胆碱正电子发射断层扫描和多参数磁共振成像联合评估显示出解剖上多样化的复发模式。这些发现对优化手术治疗后前列腺癌复发患者的挽救治疗具有重要意义。
