Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra; Faculty of Medicine, Coimbra University, Coimbra.
Faculty of Medicine, Coimbra University, Coimbra; Department of Nuclear Medicine; Coimbra University Hospital Center, Coimbra.
Arch Ital Urol Androl. 2021 Mar 18;93(1):21-25. doi: 10.4081/aiua.2021.1.21.
Clinical approach of prostate cancer (PCa) biochemical recurrence (BCR) is an ever-changing topic. Prostate-specific membrane antigen positron emission tomography ([68Ga]Ga-PSMA-11 PET-CTPSMA PET-CT) has shown good potential in this field. The aim is to evaluate PSMA PET-CT detection rate in PCa BCR and assess its impact on clinical outcome.
Out of 319 patients with PCa who underwent PSMA PET-CT between October 2015 and June 2019, 70 had developed BCR after treatment with curative intent. Two groups were created: one with BCR after surgery (RP group) (N: 48; 68.6%) and other with BCR after radiotherapy (RT group) (N: 22; 31.4%). Clinical, analytical, pathological and PSMA PET-CT results were evaluated.
Initial age was different between groups (p = 0.008). RP patients were mainly at intermediate risk (85.1% vs 42.9%, p = 0.001) while RT patients were at low risk of recurrence (8.5% vs 47.6%, p = 0.001). In RP and RT groups, PSMA PETCT detected, respectively, pelvic relapse in 31.3% and 63.6%, and extrapelvic relapse in 18.8% and 31.8%. Salvage treatment was performed in 61.9% (n = 26) of RP patients and in 15% (n = 3) of RT patients, p < 0.001. Of RP patients submitted to salvage treatment, 59.1% achieved complete remission. Concerning these patients, local radiotherapy led to complete remission in 68.4% (n = 13). Of RT patients submitted to salvage treatment, two had complete remission and one had partial remission.Concerning detection rate, PSMA PET-CT was positive for pelvic relapse when pre-PET PSA ≥ 0.8 ng/mL (RP) or ≥ 2.3 ng/mL (RT) and for extrapelvic relapse when PSA ≥ 0.4 ng/mL (RP) or ≥ 3.5 ng/mL (RT), p > 0.05.
Biochemical persistence rate after salvage therapy was similar (30-40%). The cut-off PSA values for pelvic relapse detected on PSMA PET-CT were ≥ 0.8 ng/mL (RP) and ≥ 2.3 ng/mL (RT).
前列腺癌（PCa）生化复发（BCR）的临床处理是一个不断变化的话题。前列腺特异性膜抗原正电子发射断层扫描（[68Ga]Ga-PSMA-11 PET-CTPSMA PET-CT）在这一领域显示出了良好的潜力。目的是评估 PSMA PET-CT 在 PCa BCR 中的检出率，并评估其对临床结局的影响。
在 2015 年 10 月至 2019 年 6 月期间接受 PSMA PET-CT 检查的 319 例 PCa 患者中，有 70 例在接受根治性治疗后出现 BCR。创建了两组：一组为手术后 BCR（RP 组）（N：48；68.6%），另一组为放疗后 BCR（RT 组）（N：22；31.4%）。评估了临床、分析、病理和 PSMA PET-CT 结果。
两组患者的初始年龄不同（p = 0.008）。RP 患者主要处于中危（85.1%比 42.9%，p = 0.001），而 RT 患者处于低复发风险（8.5%比 47.6%，p = 0.001）。在 RP 和 RT 组中，PSMA PETCT 分别检测到骨盆复发 31.3%和 63.6%，骨盆外复发 18.8%和 31.8%。RP 患者中有 61.9%（n = 26）接受了挽救性治疗，RT 患者中有 15%（n = 3）接受了挽救性治疗，p < 0.001。RP 患者接受挽救性治疗后，59.1%完全缓解。对于这些患者，局部放疗使 68.4%（n = 13）患者完全缓解。RT 患者接受挽救性治疗后，2 例完全缓解，1 例部分缓解。就检出率而言，当 PSAPET PSA 水平≥0.8ng/mL（RP）或≥2.3ng/mL（RT）时，PSMA PET-CT 对骨盆复发呈阳性，当 PSA 水平≥0.4ng/mL（RP）或≥3.5ng/mL（RT）时，PSMA PET-CT 对骨盆外复发呈阳性，p > 0.05。
挽救性治疗后的生化无进展率相似（30-40%）。PSMA PET-CT 检测到的骨盆复发的 PSA 截断值为≥0.8ng/mL（RP）和≥2.3ng/mL（RT）。
