Department of Urology, Technical University of Munich, Munich, Germany.
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
J Urol. 2021 Jun;205(6):1663-1670. doi: 10.1097/JU.0000000000001596. Epub 2021 Feb 4.
We sought to address the impact of preoperative prostate specific membrane antigen (PSMA) positron emission tomography (PET) findings prior to radical prostatectomy and pelvic lymph node dissection on biochemical recurrence and time to adjuvant or salvage treatment.
Between 2013 and 2017, 64 intermediate and 166 high risk (230) prostate cancer patients received Ga-PSMA-11 PET followed by radical prostatectomy and pelvic lymph node dissection. Biochemical recurrence-free and therapy-free survivalwere determined. For all time-to-event analyses, univariable and multivariable Cox proportional hazards models and univariable Kaplan-Meier analyses were applied, with a significance threshold of p <0.05.
The overall sensitivity, specificity, positive predictive value and negative predictive value of PSMA PET for pN1 disease was 48.5%, 95.7%, 82.1% and 82.2%, respectively. Median followup was 30.2 months. Biochemical recurrence occurred in 50.4% (116) of patients and adjuvant or salvage treatment was performed in 46.5% (107). Worst biochemical recurrence-free and therapy-free survival was observed in pN1 patients who also exhibited PSMA PET positive lymph node, followed by pN1 patients without PSMA PET positive lymph node and patients without evidence of lymph node metastasis on histology and PSMA PET (median biochemical recurrence-free survival 1.7 vs. 7.5 vs. >36 months, median therapy-free survival 2.6 vs. 8.9 vs. >36 months).
Patients with positive lymph node on PSMA PET prior to radical prostatectomy have to expect early biochemical recurrence and adjuvant/salvage therapy, despite thorough pelvic lymph node dissection. Therefore, results from PSMA PET can be used for patients' consultation and more stringent followup as well as for planning of neoadjuvant/adjuvant therapy.
我们旨在探讨根治性前列腺切除术和盆腔淋巴结清扫术前前列腺特异膜抗原（PSMA）正电子发射断层扫描（PET）检查结果对生化复发和辅助或挽救性治疗时间的影响。
2013 年至 2017 年间，64 例中危和 166 例高危（230 例）前列腺癌患者接受 Ga-PSMA-11 PET 检查后行根治性前列腺切除术和盆腔淋巴结清扫术。确定生化无复发生存和无治疗生存。所有时间相关事件分析均采用单变量和多变量 Cox 比例风险模型以及单变量 Kaplan-Meier 分析，显著性阈值为 p<0.05。
PSMA PET 对 pN1 疾病的总体敏感性、特异性、阳性预测值和阴性预测值分别为 48.5%、95.7%、82.1%和 82.2%。中位随访时间为 30.2 个月。50.4%（116 例）患者发生生化复发，46.5%（107 例）患者行辅助或挽救性治疗。pN1 患者中，同时存在 PSMA PET 阳性淋巴结的患者生化无复发生存和无治疗生存最差，其次是 pN1 患者无 PSMA PET 阳性淋巴结和组织学和 PSMA PET 无淋巴结转移的患者（中位生化无复发生存 1.7 个月 vs. 7.5 个月 vs. >36 个月，中位无治疗生存 2.6 个月 vs. 8.9 个月 vs. >36 个月）。
尽管进行了彻底的盆腔淋巴结清扫术，但在根治性前列腺切除术前行 PSMA PET 检查发现阳性淋巴结的患者仍需预期早期生化复发和辅助/挽救性治疗。因此，PSMA PET 的结果可用于患者咨询和更严格的随访以及新辅助/辅助治疗的规划。
