Slevin Finbar, Beasley Matthew, Cross William, Scarsbrook Andrew, Murray Louise, Henry Ann
Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
University of Leeds, Leeds, United Kingdom.
Adv Radiat Oncol. 2020 Aug 31;5(6):1126-1140. doi: 10.1016/j.adro.2020.07.009. eCollection 2020 Nov-Dec.
There is increasing use of radical prostatectomy to treat patients with high-risk prostate cancer. This has contributed toward a pathologic stage migration, and a greater number of patients are subsequently being diagnosed with biochemical failure. There is increasing use of advanced imaging techniques in the setting of biochemical failure, including positron emission tomography-computed tomography (PET-CT).
This critical literature review highlights the evidence for PET-CT in postprostatectomy biochemical failure and identifies sites of pelvic lymph node relapse in the setting of biochemical failure and the potential implications that the locations of these relapses may have for salvage therapies. Potential future directions are then considered.
The optimal PET-CT tracer remains uncertain but there is increasing use of prostate-specific membrane antigen PET-CT for investigating sites of nodal metastasis at low prostate-specific antigen levels, and this is leading to a blurring of the biochemical and radiologic recurrence phases. The optimal therapeutic approach remains undefined, with current trials investigating postoperative radiation therapy to the whole pelvis in addition to the prostatic fossa, the use of PET-CT in the setting of biochemical recurrence to guide delivery of salvage radiation therapy, and, for patients with node-only relapsed prostate cancer, the addition of whole pelvis radiation therapy to metastasis-directed therapies such as stereotactic ablative radiotherapy.
The most appropriate target volume for salvage radiation therapy remains uncertain, and the findings of studies using PET-CT to map nodal recurrences suggest that there could be a role for extending whole pelvis radiation therapy volumes to increase coverage of superior nodal regions. The emerging fields of radiomics and radiogenomics could provide important prognostic information and aid decision making for patients with relapsed prostate cancer.
根治性前列腺切除术在高危前列腺癌患者治疗中的应用日益广泛。这导致了病理分期的迁移，随后更多患者被诊断为生化复发。在生化复发的情况下，包括正电子发射断层扫描-计算机断层扫描（PET-CT）在内的先进成像技术的应用也越来越多。
这篇重要的文献综述强调了PET-CT在前列腺切除术后生化复发中的证据，确定了生化复发情况下盆腔淋巴结复发的部位，以及这些复发部位对挽救性治疗可能产生的潜在影响。然后考虑了潜在的未来方向。
最佳的PET-CT示踪剂仍不确定，但越来越多地使用前列腺特异性膜抗原PET-CT来研究低前列腺特异性抗原水平下的淋巴结转移部位，这导致生化复发和放射学复发阶段的界限变得模糊。最佳治疗方法仍不明确，目前的试验正在研究除前列腺窝外对整个盆腔进行术后放疗、在生化复发时使用PET-CT来指导挽救性放疗的实施，以及对于仅出现淋巴结复发的前列腺癌患者，在立体定向消融放疗等转移灶定向治疗的基础上增加全盆腔放疗。
挽救性放疗最合适的靶区仍不确定，使用PET-CT绘制淋巴结复发情况的研究结果表明，扩大全盆腔放疗范围以增加对上淋巴结区域的覆盖可能具有一定作用。放射组学和放射基因组学等新兴领域可为复发前列腺癌患者提供重要的预后信息并辅助决策。
