De Bruycker Aurélie, Lambert Bieke, Claeys Tom, Delrue Louke, Mbah Chamberlain, De Meerleer Gert, Villeirs Geert, De Vos Filip, De Man Kathia, Decaestecker Karel, Fonteyne Valérie, Lumen Nicolaas, Ameye Filip, Billiet Ignace, Joniau Steven, Vanhaverbeke Friedl, Duthoy Wim, Ost Piet
Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Gent, Belgium.
Department of Radiology and Nuclear Medicine, Ghent University, Gent, Belgium.
BJU Int. 2017 Dec;120(6):815-821. doi: 10.1111/bju.13938. Epub 2017 Jul 16.
To describe the anatomical patterns of prostate cancer (PCa) recurrence after primary therapy and to investigate if patients with low-volume disease have a better prognosis as compared with their counterparts.
Patients eligible for an 18-F choline positron-emission tomography (PET)-computed tomography (CT) were enrolled in a prospective cohort study. Eligible patients had asymptomatic biochemical recurrence after primary PCa treatment and testosterone levels >50 ng/mL. The number of lesions was counted per scan. Patients with isolated local recurrence (LR) or with ≤3 metastases (with or without LR) were considered to have low-volume disease and patients with >3 metastases to have high-volume disease. Descriptive statistics were used to report recurrences. Cox regression analysis was used to investigate the influence of prognostic variables on the time to developing castration-resistant PCa (CRPC).
In 208 patients, 625 sites of recurrence were detected in the lymph nodes (N1/M1a: 30%), the bone (18%), the prostate (bed; 11%), viscera (4%), or a combination of any of the previous (37%). In total, 153 patients (74%) had low-volume recurrence and 55 patients (26%) had high-volume recurrence. The 3-year CRPC-free survival rate for the whole cohort was 79% (95% confidence interval 43-55), 88% for low-volume recurrences and 50% for high-volume recurrences (P < 0.001). Longer PSA doubling time at time of recurrence and low-volume disease were associated with a longer time to CRPC.
Three out of four patients with PCa with a 18-F choline PET-CT-detected recurrence have low-volume disease, potentially amenable to local therapy. Patients with low-volume disease have a better prognosis as compared with their counterparts. Lymph node recurrence was the most dominant failure pattern.
描述前列腺癌（PCa）初次治疗后复发的解剖学模式，并研究与疾病体积较小的患者相比，疾病体积较大的患者预后是否更好。
符合18F胆碱正电子发射断层扫描（PET）-计算机断层扫描（CT）检查条件的患者被纳入一项前瞻性队列研究。符合条件的患者在PCa初次治疗后出现无症状生化复发，且睾酮水平>50 ng/mL。每次扫描统计病灶数量。孤立局部复发（LR）或转移灶≤3个（无论有无LR）的患者被视为疾病体积较小，转移灶>3个的患者被视为疾病体积较大。采用描述性统计报告复发情况。采用Cox回归分析研究预后变量对去势抵抗性PCa（CRPC）发生时间的影响。
208例患者中，在淋巴结（N1/M1a：30%）、骨骼（18%）、前列腺（床；11%）、内脏（4%）或上述任何部位的组合（37%）检测到625个复发部位。总体而言，153例患者（74%）为疾病体积较小的复发，55例患者（26%）为疾病体积较大的复发。整个队列的3年无CRPC生存率为79%（95%置信区间43 - 55），疾病体积较小的复发患者为88%，疾病体积较大的复发患者为50%（P < 0.001）。复发时较长的前列腺特异抗原（PSA）倍增时间和疾病体积较小与发生CRPC的时间较长相关。
在通过18F胆碱PET-CT检测到复发的PCa患者中，四分之三的患者疾病体积较小，可能适合局部治疗。与疾病体积较大的患者相比，疾病体积较小的患者预后更好。淋巴结复发是最主要的失败模式。
