根治性治疗后前列腺癌患者 PSA 检测不到时，18F-氟氯维司 PET/CT 是否有作用？

Is There Any Role for 18F-Fluciclovine PET/CT in the Presence of Undetectable PSA in Prostate Cancer Patients After Definitive Treatment?

机构信息

Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

From the Division of Diagnostic Imaging, Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.

出版信息

Clin Nucl Med. 2020 Sep;45(9):672-678. doi: 10.1097/RLU.0000000000003122.

DOI:10.1097/RLU.0000000000003122

PMID:32604105

Abstract

PURPOSE

The aim of this study was to investigate the role of F-fluciclovine PET/CT in the evaluation of prostate cancer (PC) patients after definitive treatment in the presence of undetectable prostate-specific antigen (PSA).

PATIENTS AND METHODS

This retrospective study was conducted in PC patients who had undetectable PSA level and underwent fluciclovine PET/CT within a 2-week interval of PSA examination and without interval treatment or other cancer. Patient and tumor characteristics at initial diagnosis, treatment regimens, and findings on fluciclovine PET/CT were collected. Comparisons between groups of positive and negative fluciclovine PET/CT were done by using descriptive statistics.

RESULTS

A total of 34 fluciclovine PET/CTs from 34 patients met the inclusion criteria. There were 4 positive (11.8%) and 30 negative fluciclovine PET/CTs (88.2%). All of the patients with positive results had an initial Gleason score of 7 or higher and locally advanced tumor (T3-T4). More common features at the time of diagnosis among positive study patients as compared with negative ones were atypical histologic variants (25% vs 0%) and very high-risk PC (50% vs 30%). Most of the patients with positive study received second-line hormonal therapy (HT) (50%), whereas patients with negative results received first-line HT (53.3%). Chemotherapy naivety was less common among positive patients (75% vs 96.7%). Sites of involvement on positive fluciclovine PET/CTs were pelvic lymph nodes (2/4, 50%), lung and mediastinal lymph node (1/4, 25%), and prostatectomy bed (1/4, 25%).

CONCLUSIONS

In the presence of undetectable PSA in PC patients after definitive treatment, fluciclovine PET/CT would benefit most to patients with Gleason score of 7 or higher, high disease burden (T3-T4), and atypical histologic variants at the time of diagnosis, and the ones who have history of second-line HT and/or chemotherapy.

摘要

目的

本研究旨在探讨 F-氟代脱氧葡萄糖 PET/CT 在前列腺癌（PC）患者根治性治疗后前列腺特异性抗原（PSA）水平无法检测时的作用。

方法

本回顾性研究纳入了 PSA 检测水平无法检测且在 PSA 检查后 2 周内进行氟代脱氧葡萄糖 PET/CT 检查、无间隔治疗或其他癌症的 PC 患者。收集患者初始诊断时的患者和肿瘤特征、治疗方案以及氟代脱氧葡萄糖 PET/CT 的结果。通过描述性统计对氟代脱氧葡萄糖 PET/CT 阳性和阴性组进行比较。

结果

共有 34 例患者的 34 次氟代脱氧葡萄糖 PET/CT 符合纳入标准。其中，氟代脱氧葡萄糖 PET/CT 阳性 4 例（11.8%），阴性 30 例（88.2%）。所有阳性结果患者的初始 Gleason 评分均为 7 分或更高，且为局部晚期肿瘤（T3-T4）。与阴性组相比，阳性组患者在诊断时更常见的特征是非典型组织学变异（25% vs 0%）和极高危 PC（50% vs 30%）。大多数阳性研究患者接受二线激素治疗（HT）（50%），而阴性研究患者接受一线 HT（53.3%）。化疗初治患者较少见（阳性患者 75% vs 96.7%）。阳性氟代脱氧葡萄糖 PET/CT 受累部位为盆腔淋巴结（2/4，50%）、肺和纵隔淋巴结（1/4，25%）和前列腺切除术床（1/4，25%）。