Service of Nuclear Medicine, S.Orsola Hospital, Bologna.
Department of Nuclear Medicine, University Hospital Essen, Essen.
J Urol. 2019 Dec;202(6):1174-1181. doi: 10.1097/JU.0000000000000417. Epub 2019 Jun 24.
Prostate specific antigen persistence after radical prostatectomy is associated with adverse outcomes in patients with prostate cancer. We sought to define regions at risk for residual disease as well as the accuracy of prostate specific membrane antigen ligand positron emission tomography in patients with prostate specific antigen persistence.
At 6 participating centers a total of 191 patients who underwent Ga-prostate specific membrane antigen-11 positron emission tomography/computerized tomography or positron emission tomography/magnetic resonance imaging for persistently elevated postoperative prostate specific antigen (0.1 ng/ml or greater) were retrospectively included in study. The detection rate and the positive predictive value were determined. In 33 patients with additional prostate specific membrane antigen ligand positron emission tomography before prostatectomy we also determined the rate of positron emission tomography based persistence and recurrence.
Prostate specific membrane antigen ligand positron emission tomography localized prostate cancer in 130 of 191 patients (68%) with prostate specific antigen persistence at a median prostate specific antigen of 1.1 ng/ml. The detection rate significantly increased with prostate specific antigen (p <0.001). Regarding prostate specific membrane antigen positron emission tomography/computerized tomography only 61 of 173 patients (35%) had disease confined to the pelvis while 57 of 173 (33%) had distant lesions. The most frequently affected nodal regions were the obturator in 42% and the presacral/mesorectal region in 40%. In 15 of the 33 patients (45%) with prostate specific membrane antigen ligand positron emission tomography before and after surgery at least 1 lesion was detected at baseline (positron emission tomography persistence), 8 (24%) had new lesions (positron emission tomography recurrence) and 10 (30%) had negative positron emission tomography findings. The positive predictive value of prostate specific membrane antigen ligand positron emission tomography was 91%. Systemic therapy initiation was significantly associated with distant lesions on prostate specific membrane antigen ligand positron emission tomography.
Prostate specific membrane antigen ligand positron emission tomography localized prostate cancer in more than two-thirds of patients with high risk features and prostate specific antigen persistence after prostatectomy. Obturator and presacral/mesorectal nodes are at high risk for persistent metastasis.
根治性前列腺切除术后前列腺特异性抗原持续存在与前列腺癌患者的不良预后相关。我们旨在确定残留疾病的风险区域，以及前列腺特异性膜抗原配体正电子发射断层扫描在前列腺特异性抗原持续存在患者中的准确性。
在 6 家参与中心，共纳入 191 例因术后前列腺特异性抗原持续升高（0.1ng/ml 或以上）而接受 Ga-前列腺特异性膜抗原-11 正电子发射断层扫描/计算机断层扫描或正电子发射断层扫描/磁共振成像检查的患者进行回顾性研究。确定了检测率和阳性预测值。在 33 例前列腺切除术前行前列腺特异性膜抗原配体正电子发射断层扫描的患者中，我们还确定了基于正电子发射断层扫描的持续性和复发性。
在中位前列腺特异性抗原为 1.1ng/ml 的 191 例前列腺特异性抗原持续存在患者中，前列腺特异性膜抗原配体正电子发射断层扫描定位前列腺癌 130 例（68%）。检测率随前列腺特异性抗原显著增加（p<0.001）。关于前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描，仅 173 例患者中有 61 例（35%）疾病局限于骨盆，而 173 例中有 57 例（33%）有远处病变。最常受累的淋巴结区域为闭孔内 42%和直肠前/中区域 40%。在 33 例（45%）前列腺特异性膜抗原配体正电子发射断层扫描术前和术后患者中，至少在基线时检测到 1 个病变（正电子发射断层扫描持续性），8 例（24%）有新病变（正电子发射断层扫描复发），10 例（30%）有阴性正电子发射断层扫描结果。前列腺特异性膜抗原配体正电子发射断层扫描的阳性预测值为 91%。系统治疗的开始与前列腺特异性膜抗原配体正电子发射断层扫描中的远处病变显著相关。
前列腺特异性膜抗原配体正电子发射断层扫描定位了前列腺癌，在 68%的前列腺切除术后前列腺特异性抗原持续存在且具有高危特征的患者中发现了这种情况。闭孔内和直肠前/中区域淋巴结转移的风险较高。
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