Liu Wei, Zukotynski Katherine, Emmett Louise, Chung Hans T, Chung Peter, Wolfson Robert, Rachinsky Irina, Kapoor Anil, Metser Ur, Loblaw Andrew, Morton Gerard, Sexton Tracy, Lock Michael, Helou Joelle, Berlin Alejandro, Boylan Colm, Archer Susan, Pond Gregory R, Bauman Glenn
Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada.
Departments of Medicine and Radiology, McMaster University, Hamilton, Canada.
Adv Radiat Oncol. 2020 Sep 9;6(1):100553. doi: 10.1016/j.adro.2020.08.010. eCollection 2021 Jan-Feb.
Our purpose was to investigate the effect of the addition of prostate-specific membrane antigen (PSMA)-targeted positron emission tomography/computed tomography (PET/CT) in patients with recurrent prostate cancer post-primary radiation therapy.
A prospective, multi-institutional clinical trial evaluated 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (F-DCFPyL) PET/CT restaging in 79 men with recurrent prostate cancer post-primary radiation therapy. We report actual patient management and compare this with proposed management both before and after PSMA-targeted PET/CT.
Most patients (59%) had a major change in actual management compared with pre-PET/CT proposed management. The rate of major change was underestimated by immediately post-PET/CT surveys (32%). Eighteen patients with PSMA avidity in the prostate gland suspicious for malignancy had a prostate biopsy. Sensitivity, specificity, and positive predictive values of PSMA uptake in the prostate were 86%, 67%, and 92%, respectively. Thirty percent of patients had directed salvage therapy and 41% underwent systemic therapy. Eleven out of 79 patients (14%) had high-dose-rate brachytherapy alone for local recurrence, and 91% were free of recurrence at a median follow-up of 20 months.
Most patients had a major change in actual management compared with pre-PSMA-targeted PET/CT planned management, and this was underestimated by post-PET/CT questionnaires.
我们的目的是研究在接受过原发性放射治疗的复发性前列腺癌患者中添加前列腺特异性膜抗原（PSMA）靶向正电子发射断层扫描/计算机断层扫描（PET/CT）的效果。
一项前瞻性、多机构临床试验评估了2-(3-{1-羧基-5-[(6-[18F]氟吡啶-3-羰基)-氨基]-戊基}-脲基)-戊二酸（F-DCFPyL）PET/CT对79例接受过原发性放射治疗的复发性前列腺癌男性患者进行再分期的情况。我们报告了实际的患者管理情况，并将其与PSMA靶向PET/CT前后的建议管理情况进行比较。
与PET/CT前的建议管理相比，大多数患者（59%）的实际管理有重大变化。PET/CT后立即进行的调查低估了重大变化的发生率（32%）。18例前列腺中PSMA摄取可疑为恶性的患者接受了前列腺活检。前列腺中PSMA摄取的敏感性、特异性和阳性预测值分别为86%、67%和92%。30%的患者接受了直接挽救治疗，41%的患者接受了全身治疗。79例患者中有11例（14%）因局部复发单独接受了高剂量率近距离放射治疗，在中位随访20个月时，91%的患者无复发。
与PSMA靶向PET/CT前计划的管理相比，大多数患者的实际管理有重大变化，而PET/CT后的问卷调查低估了这一情况。
