Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Clinic of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Eur J Clin Invest. 2019 Mar;49(3):e13063. doi: 10.1111/eci.13063. Epub 2019 Jan 11.
Serum prostate-specific antigen (PSA) may predict the risk of positive positron emission tomography/computed tomography with radiolabelled prostate-specific membrane antigen (PSMA-PET/CT) in patients with biochemical recurrent prostate cancer (BRPCa). However, to date, there are no clear data regarding the correlation between PSA kinetics and PSMA-PET findings. We performed a systematic review and meta-analysis to provide evidence-based data in this setting.
A comprehensive literature search of studies published through October 2018 in PubMed/MEDLINE, EMBASE and Cochrane library databases was performed. A meta-analysis to establish the detection rate (DR) of PSMA-PET using different cut-off values of PSA doubling time (PSAdt) and a pooled analysis to establish whether shorter PSAdt may predict positive PSMA-PET results was performed in patients with BRPCa.
Twelve articles were included in the systematic review, and eight articles (including about 1400 patients) were selected for the meta-analysis. The pooled DR including 95% confidence intervals (95%CI) of PSMA-PET in restaging prostate cancer (PCa) patients was 72% (95%CI:60%-82%), increasing to 83% (95%CI:75%-90%) when PSAdt was ≤6 months and decreasing to 60% (95%CI:37%-80%) when PSAdt was >6 months, without a statistical significant difference. PSAdt ≤6 months may predict the positive result of PSMA-PET (pooled odds ratio: 3.22; 95%CI:1.17-8.88). Statistical heterogeneity among the included studies was found.
PSA kinetics, and in particular shorter PSAdt, may be predictor of PSMA-PET positivity in patients with BRPCa. Further larger studies in this setting are warranted.
血清前列腺特异性抗原（PSA）可能预测生化复发性前列腺癌（BRPCa）患者放射性标记前列腺特异性膜抗原（PSMA-PET/CT）阳性的风险。然而，迄今为止，关于 PSA 动力学与 PSMA-PET 结果之间的相关性尚无明确数据。我们进行了系统评价和荟萃分析，以提供该领域的循证数据。
对截至 2018 年 10 月在 PubMed/MEDLINE、EMBASE 和 Cochrane 图书馆数据库中发表的研究进行了全面的文献检索。在 BRPCa 患者中，我们进行了一项荟萃分析，以确定使用不同 PSA 倍增时间（PSAdt）截断值的 PSMA-PET 的检测率（DR），并进行了一项汇总分析以确定较短的 PSAdt 是否可以预测 PSMA-PET 阳性结果。
系统评价纳入了 12 篇文章，其中 8 篇（包括约 1400 例患者）被纳入荟萃分析。包括 95%置信区间（95%CI）的 PSMA-PET 在前列腺癌（PCa）患者再分期中的汇总 DR 为 72%（95%CI：60%-82%），当 PSAdt≤6 个月时增加到 83%（95%CI：75%-90%），而当 PSAdt>6 个月时则降低到 60%（95%CI：37%-80%），但无统计学显著差异。PSAdt≤6 个月可能预测 PSMA-PET 的阳性结果（汇总优势比：3.22；95%CI：1.17-8.88）。纳入研究之间存在统计学异质性。
PSA 动力学，特别是较短的 PSAdt，可能是 BRPCa 患者 PSMA-PET 阳性的预测指标。在这一领域需要进一步进行更大规模的研究。
