Keegan Niamh M, Bodei Lisa, Morris Michael J
Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Eur Urol Focus. 2021 Mar;7(2):267-278. doi: 10.1016/j.euf.2021.03.012. Epub 2021 Mar 18.
Men with biochemically relapsed prostate cancer face a clinical conundrum. Depending on the detected distribution of disease, treatment goals may range from cure with focal therapy to palliative with systemic therapy to expectant observation. Retrospective studies of prostate-specific membrane antigen (PSMA)-based imaging demonstrate higher disease detection rates than conventional imaging.
This review focuses on available prospective evidence for diagnostic use of PSMA-based imaging to accurately restage recurrent prostate cancer and explores the potential clinical impact, near future uses, and challenges for PSMA-based imaging in this setting.
PubMed and EMBASE databases were searched for prospective studies with primary, secondary, or exploratory endpoints evaluating PSMA-based imaging for patients with recurrent prostate cancer published in English in the past 10 yrs.
We reviewed 48 prospective studies evaluating the role of PSMA positron emission tomography (PET) in recurrent prostate cancer. These studies establish the diagnostic accuracy and safety of PSMA PET using the Ga-PSMA-11 and F-DCFPyL radiotracers even at lower prostate-specific antigen (PSA) levels (0.5 ≤ PSA < 1.0 ng/m: disease detection rate 51-78%). The use of PSMA PET has been shown to result in changes in management in up to two-thirds of patients.
There is now higher-level regulatory-quality prospective evidence for PSMA-based imaging for the detection of recurrent prostate cancer. There is prospective evidence of superiority over cross-sectional imaging and bone scintigraphy, as well as for the alterations in disease management as a result of PSMA-based imaging.
When the prostate-specific antigen (PSA) level is rising after primary therapy, prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is excellent at detecting and localizing prostate cancer, even at low PSA levels. Those who benefit best from treatment modifications based on PSMA PET findings are yet to be defined.
生化复发的前列腺癌男性患者面临临床难题。根据检测到的疾病分布情况，治疗目标可能从局部治疗治愈到全身治疗姑息治疗再到观察等待。基于前列腺特异性膜抗原（PSMA）成像的回顾性研究显示，其疾病检出率高于传统成像。
本综述聚焦于基于PSMA成像用于准确重新分期复发性前列腺癌的现有前瞻性证据，并探讨基于PSMA成像在该情况下的潜在临床影响、近期用途及挑战。
检索PubMed和EMBASE数据库，查找过去10年以英文发表的、以评估基于PSMA成像用于复发性前列腺癌患者的主要、次要或探索性终点的前瞻性研究。
我们回顾了48项评估PSMA正电子发射断层扫描（PET）在复发性前列腺癌中作用的前瞻性研究。这些研究证实了使用镓-PSMA-11和F-DCFPyL放射性示踪剂的PSMA PET的诊断准确性和安全性，即使在较低的前列腺特异性抗原（PSA）水平（0.5≤PSA<1.0 ng/m：疾病检出率51-78%）。已证明使用PSMA PET可使多达三分之二的患者治疗方案发生改变。
现在有更高质量的基于PSMA成像检测复发性前列腺癌的监管级前瞻性证据。有前瞻性证据表明其优于横断面成像和骨闪烁显像，以及基于PSMA成像导致疾病管理的改变。
在初始治疗后前列腺特异性抗原（PSA）水平升高时，前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）即使在低PSA水平下也能出色地检测和定位前列腺癌。基于PSMA PET结果从治疗调整中获益最大的人群尚待确定。
