Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium.
World J Urol. 2021 Feb;39(2):399-406. doi: 10.1007/s00345-020-03220-0. Epub 2020 May 16.
Salvage radiotherapy (RT) (± androgen deprivation therapy (ADT)) is often used as a treatment in patients with biochemical recurrence (BCR) following radical prostatectomy (RP). Unfortunately, even after RT ± ADT, a significant number of patients will develop 'second' BCR. The aim of this study was to investigate the impact of postoperative treatments (adjuvant/salvage radiotherapy (RT) ± androgen deprivation therapy) on the recurrence pattern in patients with BCR following RP assessed by 11C-Choline PET/CT or 68 Ga-PSMA PET/CT.
Patients who developed BCR following RP and who had at least one positive lesion on PET/CT were retrospectively assessed. Positive spots were mapped as local, lymph node (LN), skeletal or visceral recurrence. A distinction was made between locoregional (prostate bed and pelvic LN) and extrapelvic recurrence (skeletal, visceral and/or extrapelvic LN). Patients were categorized according to postoperative treatment received in three subgroups (RT, ADT and RT + ADT) and compared with the reference group (RP only). The impact of the radiation field was also investigated.
We identified 200 patients assessed by Ga-PSMA-11 (80%) or C-Choline PET/CT (20%). Patients who received postoperative RT + ADT had less LN recurrence distal to the common iliac bifurcation (26.7% vs 66.6%; p = 0.0004), but more recurrence to retroperitoneal LN than the reference group (38% vs. 14.4%, p = 0.02). Moreover, the RT + ADT subgroup had more extrapelvic recurrence compared to the reference group (66.2% vs 40.8%, p = 0.02). Patients who received RT to the prostate bed had more recurrence distal to the common iliac bifurcation compared to those who received RT to the prostate bed + pelvic LN (51.6% vs 26.1%, p = 0.0069).
Post-prostatectomy treatments (ADT and/or RT) and the postoperative radiation field (prostate bed vs. prostate bed + pelvis) have a significant impact on the recurrence pattern. This knowledge can help clinicians to counsel their patients on their chances of being eligible for (locoregional) metastasis-directed therapies.
挽救性放疗（RT）（±雄激素剥夺疗法（ADT））常被用作根治性前列腺切除术（RP）后生化复发（BCR）患者的治疗方法。不幸的是，即使在 RT±ADT 后，仍有相当数量的患者会出现“第二次”BCR。本研究的目的是通过 11C-胆碱 PET/CT 或 68 Ga-PSMA PET/CT 评估 RP 后 BCR 患者术后治疗（辅助/挽救性 RT±ADT）对复发模式的影响。
回顾性评估 RP 后发生 BCR 且至少有一个阳性 PET/CT 病灶的患者。阳性点被映射为局部、淋巴结（LN）、骨骼或内脏复发。将局部区域（前列腺床和骨盆 LN）和盆腔外复发（骨骼、内脏和/或盆腔外 LN）区分开来。根据术后接受的治疗，患者被分为三组（RT、ADT 和 RT+ADT），并与参考组（仅 RP）进行比较。还研究了放射野的影响。
我们共评估了 200 例接受 Ga-PSMA-11（80%）或 C-胆碱 PET/CT（20%）检查的患者。接受术后 RT+ADT 的患者，髂总分叉以下的 LN 远处复发较少（26.7%比 66.6%；p=0.0004），但腹膜后 LN 复发多于参考组（38%比 14.4%，p=0.02）。此外，RT+ADT 亚组与参考组相比，盆腔外复发更多（66.2%比 40.8%，p=0.02）。接受前列腺床 RT 的患者，与接受前列腺床+骨盆 LN RT 的患者相比，在髂总分叉以下的复发更多（51.6%比 26.1%，p=0.0069）。
前列腺切除术的术后治疗（ADT 和/或 RT）和术后放射野（前列腺床 vs. 前列腺床+骨盆）对复发模式有显著影响。这些知识可以帮助临床医生为患者提供有关他们是否有资格接受（局部）转移性定向治疗的信息。
