School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.
J Med Imaging Radiat Oncol. 2021 Oct;65(6):649-654. doi: 10.1111/1754-9485.13162. Epub 2021 Mar 5.
There has been a growing body of evidence highlighting the improved sensitivity and specificity for prostate specific membrane antigen (PSMA) positron emission tomography (PET) in advanced prostate cancer imaging. We aimed to assess prostate cancer staging practice patterns in Australia using population-based data.
We extracted data on men diagnosed with prostate cancer between October 2016 and December 2018 from the Prostate Cancer Outcomes Registry-Victoria (PCOR-Vic). We evaluated trends and comparisons between patients receiving PET/CT (with or without conventional imaging (CImg)), and CImg alone, and analysed imaging modality as predictor of clinical regional node positive disease (cN1 vs cN0/X), metastatic disease (cM1 vs cM0/X), and treatment received.
In total, 6139 patients in the registry had either a staging PET scan (n = 889, 14%), CImg without PET scan (n = 2464, 40%), or no recorded PET or CImg (n = 2786, 45%). The proportion of allimaged patients who received staging PET increased from 19% to 36% from the first to last three-month period, and in the high-risk category the increase was 23-43%. After adjustment for grade group, PET vs CImg-only patients were observed to have a higher proportion of cN1 disease (OR = 2.46, 95% CI: 1.90-3.20) but not cM1 disease (OR = 1.10, 95% CI: 0.84-1.44).
Our registry data highlights the rapid uptake of PET imaging, particularly in high-risk disease. Based on this data, we highlight the increased diagnosis of nodal disease, thus potentially optimizing patient selection prior to definitive treatment for prostate cancer.
越来越多的证据表明，前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）在晚期前列腺癌成像中具有更高的敏感性和特异性。我们旨在使用基于人群的数据评估澳大利亚前列腺癌分期的实践模式。
我们从前列腺癌结果登记处-维多利亚州（PCOR-Vic）中提取了 2016 年 10 月至 2018 年 12 月期间诊断为前列腺癌的男性的数据。我们评估了接受 PET/CT（有或无常规成像（CImg））和仅 CImg 的患者之间的趋势和比较，并分析了成像方式作为临床区域淋巴结阳性疾病（cN1 与 cN0/X）、转移性疾病（cM1 与 cM0/X）和治疗接受的预测因素。
在该登记处中，共有 6139 名患者进行了分期 PET 扫描（n=889，14%）、无 PET 扫描的 CImg（n=2464，40%）或未记录 PET 或 CImg（n=2786，45%）。所有接受影像学检查的患者中，接受分期 PET 的患者比例从第一个三个月到最后一个三个月从 19%增加到 36%，在高危组中增加了 23-43%。在调整了分级组后，与仅接受 CImg 的患者相比，PET 检查的患者 cN1 疾病的比例更高（OR=2.46，95%CI：1.90-3.20），但 cM1 疾病的比例没有差异（OR=1.10，95%CI：0.84-1.44）。
我们的登记处数据强调了 PET 成像的快速应用，特别是在高危疾病中。基于这些数据，我们强调了淋巴结疾病的诊断增加，从而可能在前列腺癌的确定性治疗之前优化患者选择。
