Division of Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.
Department of Urology, Mayo Clinic, Rochester, Minnesota.
J Urol. 2020 Aug;204(2):296-302. doi: 10.1097/JU.0000000000000800. Epub 2020 Feb 18.
We compared the use of C-choline and Ga-prostate specific membrane antigen in men undergoing salvage lymph node dissection for nodal recurrent prostate cancer.
The study included 641 patients who experienced prostate specific antigen rise and nodal recurrence after radical prostatectomy and underwent salvage lymph node dissection. Lymph node recurrence was documented by positron emission tomography/computerized tomography using C-choline (407, 63%) or Ga-PSMA ligand (234, 37%). The outcome was underestimation of tumor burden (difference between number of positive nodes on final pathology and number of positive spots at positron emission tomography/computerized tomography). Multivariable analysis tested the association between positron emission tomography/computerized tomography tracer (C-choline vs Ga-PSMA) and tumor burden underestimation.
Overall the extent of tumor burden underestimation was significantly higher in the C-choline group compared to the Ga-PSMA group (p <0.0001), which was confirmed on multivariable analysis (p=0.028). Repeating these analyses according to prostate specific antigen, tumor burden underestimation was lower with Ga-PSMA only when prostate specific antigen was 1.5 ng/ml or less. Conversely, the underestimation of the 2 tracers became similar when prostate specific antigen was greater than 1.5 ng/ml. Furthermore, we evaluated the risk of underestimation by number of positive spots on positron emission tomography/computerized tomography. The higher the number of positive spots the higher the underestimation of tumor burden regardless of the tracer used (p=0.2).
Positron emission tomography/computerized tomography significantly underestimates the burden of prostate cancer recurrence, regardless of the tracer used. Ga-PSMA was associated with a lower rate of underestimation in patients with a prostate specific antigen below 1.5 ng/ml and a limited nodal tumor load. In all other men there was no benefit from Ga-PSMA over C-choline in assessing the extent of nodal recurrence.
我们比较了 C-胆碱和 Ga-前列腺特异性膜抗原在因淋巴结复发前列腺癌而行挽救性淋巴结清扫术的男性中的应用。
本研究纳入了 641 名在根治性前列腺切除术后前列腺特异性抗原升高和淋巴结复发并接受挽救性淋巴结清扫术的患者。通过正电子发射断层扫描/计算机断层扫描（使用 C-胆碱[407 例，63%]或 Ga-PSMA 配体[234 例，37%]）记录淋巴结复发情况。将肿瘤负荷的低估（最终病理上阳性淋巴结的数量与正电子发射断层扫描/计算机断层扫描上阳性点的数量之间的差异）作为结局。多变量分析测试了正电子发射断层扫描/计算机断层扫描示踪剂（C-胆碱与 Ga-PSMA）与肿瘤负荷低估之间的相关性。
总体而言，C-胆碱组肿瘤负荷低估的程度明显高于 Ga-PSMA 组（p<0.0001），多变量分析也证实了这一点（p=0.028）。根据前列腺特异性抗原进行重复分析，只有当前列腺特异性抗原为 1.5ng/ml 或更低时，Ga-PSMA 才会降低肿瘤负荷的低估。相反，当前列腺特异性抗原大于 1.5ng/ml 时，两种示踪剂的低估程度变得相似。此外，我们还评估了正电子发射断层扫描/计算机断层扫描上阳性点数量与低估风险的关系。无论使用哪种示踪剂，阳性点数量越多，肿瘤负荷的低估程度越高（p=0.2）。
正电子发射断层扫描/计算机断层扫描显著低估了前列腺癌复发的负荷，无论使用哪种示踪剂。在前列腺特异性抗原低于 1.5ng/ml 和淋巴结肿瘤负荷有限的患者中，Ga-PSMA 与较低的低估率相关。在所有其他男性中，Ga-PSMA 在评估淋巴结复发程度方面并不优于 C-胆碱。
