Department of Urology, Amsterdam University Medical Center, VU University, Prostate Cancer Network Netherlands, Amsterdam, The Netherlands;
Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands.
J Nucl Med. 2021 Jul 1;62(7):961-967. doi: 10.2967/jnumed.120.252528. Epub 2020 Nov 6.
Since the introduction of radiolabeled prostate-specific membrane antigen (PSMA) PET/CT, the ability to visualize recurrent prostate cancer has improved substantially. However, diagnostic accuracy is largely lacking for radiolabeled PSMA PET/CT in patients with biochemical persistence (BCP; that is, persistently measurable prostate-specific antigen [PSA] values after robot-assisted laparoscopic radical prostatectomy [RARP]). Therefore, the aim of this study was to determine the role of PSMA (i.e.,F-DCFPyL or Ga-PSMA-11) PET/CT imaging in patients who experience BCP after RARP and to evaluate the sites of persistent disease on PSMA PET/CT. In total, 150 consecutive patients with BCP after RARP who underwent radiolabeled PSMA PET/CT imaging were retrospectively evaluated. BCP was defined as any detectable first serum PSA value after RARP (≥0.1 ng/mL) at least 6 wk after surgery, in the absence of an undetectable PSA value after RARP. A multivariable logistic regression analysis was performed to identify predictors for the detection of metastases outside the prostatic fossa (≥miN1) on PSMA PET/CT. PSMA PET/CT was performed at a median PSA value of 0.60 ng/mL (interquartile range, 0.3-2.4) after a median of 6 mo (interquartile range, 4-10) after RARP. In total, 101 of 150 patients (67%) had lesions with PSMA expression on PET/CT, and 89 of 150 (59%) had lesions with increased PSMA expression sites outside the prostatic fossa. Moreover, 39 of 150 patients (26%) had PSMA-positive lesions outside the pelvis. On multivariable analysis, higher PSA values after RARP ( = 0.004) and positive pathologic lymph node status ( = 0.006) were independent predictors for ≥miN1. In the presence of BCP, a high proportion of patients already had disease metastatic to the pelvic lymph nodes or showed evidence of distant metastases, as indicated by PSMA PET/CT. Higher PSA levels after RARP and positive pathologic lymph node status were significantly associated with metastases outside the prostatic fossa. In patients with BCP, PSMA PET/CT imaging is warranted to guide salvage treatment strategies.
自放射性标记前列腺特异性膜抗原（PSMA）PET/CT 问世以来，检测复发性前列腺癌的能力有了显著提高。然而，对于接受机器人辅助腹腔镜根治性前列腺切除术（RARP）后生化持续存在（BCP；即 PSA 值持续可测量）的患者，放射性标记 PSMA PET/CT 的诊断准确性仍然存在很大的不足。因此，本研究旨在确定 PSMA（即 F-DCFPyL 或 Ga-PSMA-11）PET/CT 成像在 RARP 后 BCP 患者中的作用，并评估 PSMA PET/CT 上持续性疾病的部位。本研究回顾性评估了 150 例接受放射性标记 PSMA PET/CT 成像的 RARP 后 BCP 连续患者。BCP 的定义为 RARP 后至少 6 周，PSA 值首次可检测到（≥0.1ng/mL），且 RARP 后 PSA 值不可检测。进行多变量逻辑回归分析，以确定 PSMA PET/CT 上检测到前列腺窝外转移（≥miN1）的预测因素。PSMA PET/CT 是在 RARP 后中位 PSA 值为 0.60ng/mL（四分位距，0.3-2.4）时进行的，中位数时间为 6 个月（四分位距，4-10）。在 150 例患者中，共有 101 例（67%）在 PET/CT 上有 PSMA 表达的病变，150 例中有 89 例（59%）在前列腺窝外有 PSMA 表达增加的病变。此外，在 150 例患者中有 39 例（26%）在骨盆外有 PSMA 阳性病变。多变量分析显示，RARP 后较高的 PSA 值（ = 0.004）和阳性病理淋巴结状态（ = 0.006）是≥miN1的独立预测因素。在存在 BCP 的情况下，相当一部分患者已经发生了盆腔淋巴结转移的疾病，或者根据 PSMA PET/CT 显示有远处转移的证据。RARP 后较高的 PSA 水平和阳性的病理淋巴结状态与前列腺窝外的转移显著相关。对于 BCP 患者，PSMA PET/CT 成像有助于指导挽救性治疗策略。
