Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Wesley Urology Clinic, Brisbane, QLD, Australia.
Prostate Cancer Prostatic Dis. 2019 Sep;22(3):385-390. doi: 10.1038/s41391-019-0163-0. Epub 2019 Jul 30.
Ga-PET/CT PSMA scan is being increasingly used for the staging of biochemically recurrent disease. Early identification of recurrent disease after radiotherapy is important in considering suitability for early salvage therapy to improve prognosis. The aim is to identify patterns of suspected prostate cancer recurrence in relation to post-radiotherapy PSA levels, especially below the accepted Phoenix definition of PSA failure (PSA nadir + 2).
This was a retrospective single tertiary institution cohort study of consecutive men between July 2014 and June 2018 who received a Ga-PSMA PET/CT for elevated PSA levels following radiotherapy as primary treatment of prostate cancer. The primary outcome measure was to determine the relationship between pre-scan PSA and the probability of identifying PSMA-avid disease suggestive of recurrent prostate cancer.
Two hundred and seventy-six patients met criteria for inclusion. The median PSA was 3.60 ng/mL. The overall detection rate for suspected recurrent prostate cancer was 86.3%. Local recurrence was the most common site, occurring in 56.9% (157/276) of men, with isolated local recurrence in 32.6% (90/276). A total of 75.3% (55/73) of men below Phoenix criteria had scans suggestive of recurrent disease, with 52.1% of men having salvageable disease. The regions surrounding the iliac arteries were the most common areas of nodal metastatic disease, with 55.6% of recurrence occurring in the iliac regions.
Ga-PSMA PET/CT frequently identifies suspected recurrent disease prior to the accepted Phoenix definition of PSA nadir +2. Prospective outcome studies are required to determine if early identification of local recurrence improves outcomes by increasing the use of salvage local treatments and whether earlier identification of metastatic disease may improve outcomes with prompt initiation of multimodality therapies.
Ga-PET/CT PSMA 扫描在生化复发疾病的分期中越来越多地被使用。在考虑是否适合早期挽救性治疗以改善预后时，早期识别放射治疗后的复发性疾病非常重要。目的是确定与放射治疗后 PSA 水平相关的疑似前列腺癌复发模式，尤其是在接受凤凰定义（PSA 最低点+2）的 PSA 失败定义之下。
这是一项回顾性的单中心连续队列研究，纳入了 2014 年 7 月至 2018 年 6 月期间因前列腺癌接受放射治疗作为主要治疗后因 PSA 水平升高而接受 Ga-PSMA PET/CT 的连续男性患者。主要观察指标是确定扫描前 PSA 与识别提示复发性前列腺癌的 PSMA 阳性疾病的可能性之间的关系。
276 例患者符合纳入标准。中位 PSA 为 3.60ng/mL。疑似复发性前列腺癌的总检出率为 86.3%。局部复发是最常见的部位，发生在 56.9%（157/276）的男性中，32.6%（90/276）的男性存在孤立性局部复发。在低于凤凰标准的 75.3%（55/73）的男性中，扫描提示存在复发性疾病，其中 52.1%的男性存在可挽救的疾病。髂动脉周围区域是淋巴结转移疾病最常见的部位，55.6%的复发发生在髂区。
Ga-PSMA PET/CT 经常在接受凤凰 PSA 最低点+2 定义之前识别出疑似复发性疾病。需要前瞻性的研究来确定早期识别局部复发是否通过增加挽救性局部治疗的使用来提高预后，以及是否早期识别转移性疾病是否可以通过及时开始多模式治疗来改善预后。
