Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.
Institute of Urology, Nanjing University, Nanjing, China.
J Urol. 2021 Apr;205(4):1082-1089. doi: 10.1097/JU.0000000000001481. Epub 2020 Nov 18.
We explored the role of Ga-PSMA-11 positron emission/computerized tomography as a predictor of pathological response to neoadjuvant androgen deprivation therapy combined with abiraterone for high risk prostate cancer.
A total of 45 patients with localized high risk prostate cancer who had serial Ga-PSMA-11 positron emission tomography/computerized tomography scans before and after 6 months of androgen deprivation therapy plus abiraterone neoadjuvant treatment followed by radical prostatectomy were included in this study. Complete pathological response or minimal residual disease <5 mm on whole mount histopathology was defined as favorable pathological response. The diagnostic performance of prostate specific antigen response and positron emission tomography/computerized tomography response for favorable pathological response was calculated. Univariable and multivariable logistic regression analyses of clinical and imaging variables were also performed to identify favorable pathological response.
Compared to the prostate specific antigen response, positron emission tomography/computerized tomography response had a significantly higher specificity in diagnosing favorable pathological response (89.7% vs 62.1%, p=0.043). Preoperative nadir prostate specific antigen (OR 0.121, 95% CI 0.028-0.529, p=0.005), posttreatment maximum standardized uptake value (OR 7.072, 95% CI 2.035-24.579, p=0.002) and posttreatment tumor volume (OR 7.896, 95% CI 1.415-44.054, p=0.018) measured on positron emission tomography/computerized tomography were significantly associated with favorable pathological response in univariable logistic regression analysis. On multivariable logistic regression analysis, only posttreatment maximum standardized uptake value was found to be an independent predictor of favorable pathological response (OR 9.69, 95% CI 1.439-65.242, p=0.020).
Ga-PSMA positron emission tomography/computerized tomography has a better diagnostic performance of pathological response to neoadjuvant treatment compared with prostate specific antigen, with maximum standardized uptake value being an independent predictive factor. This pilot study suggests that prostate specific membrane antigen positron emission tomography/computerized tomography may serve as a potential predictor of pathological response to neoadjuvant treatment.
我们探讨了 Ga-PSMA-11 正电子发射/计算机断层扫描作为预测高危前列腺癌新辅助去势治疗联合阿比特龙的病理反应的作用。
本研究共纳入 45 例接受 6 个月去势治疗联合阿比特龙新辅助治疗及根治性前列腺切除术的局部高危前列腺癌患者。全器官组织病理检查完全病理反应或残留病灶<5mm 定义为有利的病理反应。计算前列腺特异抗原反应和正电子发射/计算机断层扫描反应对有利病理反应的诊断性能。还进行了单变量和多变量逻辑回归分析，以确定有利的病理反应。
与前列腺特异抗原反应相比，正电子发射/计算机断层扫描反应在诊断有利病理反应方面具有更高的特异性（89.7%比 62.1%，p=0.043）。术前最低前列腺特异抗原（OR 0.121，95%CI 0.028-0.529，p=0.005）、治疗后最大标准化摄取值（OR 7.072，95%CI 2.035-24.579，p=0.002）和治疗后肿瘤体积（OR 7.896，95%CI 1.415-44.054，p=0.018）与单变量逻辑回归分析中有利的病理反应显著相关。多变量逻辑回归分析显示，只有治疗后最大标准化摄取值是有利病理反应的独立预测因素（OR 9.69，95%CI 1.439-65.242，p=0.020）。
Ga-PSMA 正电子发射/计算机断层扫描在预测新辅助治疗的病理反应方面优于前列腺特异抗原，最大标准化摄取值是独立的预测因素。这项初步研究表明，前列腺特异膜抗原正电子发射/计算机断层扫描可能成为新辅助治疗病理反应的潜在预测指标。
