Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
Prostate Cancer Prostatic Dis. 2021 Sep;24(3):910-916. doi: 10.1038/s41391-021-00347-y. Epub 2021 Mar 31.
High-risk prostate cancer is associated with adverse pathology and unfavorable outcomes after radical prostatectomy. Ga-PSMA PET/CT is more accurate than conventional imaging for preoperative staging. We aimed to evaluate whether lymph node involvement on Ga-PSMA PET/CT prior to radical prostatectomy in patients with high-risk prostate cancer is associated with worse short-term oncologic outcomes.
We retrospectively reviewed 149 patients with high-risk localized or locoregional prostate cancer who underwent Ga-PSMA PET/CT prior to radical prostatectomy between 2015 and 2020. None of the patients received neoadjuvant or adjuvant treatment. The study endpoints were PSA persistence and biochemical recurrence. Logistic regression models were used to identify preoperative predictors of PSA persistence. Kaplan-Meier analyses were used to estimate biochemical recurrence-free survival.
Of 149 identified patients, 19 (13%) were found to have lymph node involvement on preoperative Ga-PSMA PET/CT. The sensitivity, specificity, and accuracy of Ga-PSMA PET/CT for identifying pathologic lymph node involvement were 68%, 95%, and 92%, respectively. PSA persistence rate was lower among patients with PET-negative lymph nodes than those with PET-positive nodes (15 vs. 84%, p < 0.001). Positive nodes on imaging (OR = 41.03, p < 0.001) and clinical T2c-T3 stage (OR = 6.96, p = 0.002) were associated with PSA persistence on multivariable analysis. Among patients with PET-negative nodes the 1- and 2-year biochemical recurrence-free survival rates were 87% and 76%, respectively.
Preoperative staging with Ga-PSMA PET/CT may identify a subgroup of high-risk prostate cancer patients with favorable short-term outcomes after radical prostatectomy without adjuvant treatment. Future studies will evaluate whether these results are sustained during long-term follow-up.
高危前列腺癌与根治性前列腺切除术后不良病理和不良预后相关。Ga-PSMA PET/CT 比传统影像学检查更准确，可用于术前分期。我们旨在评估高危前列腺癌患者在根治性前列腺切除术前 Ga-PSMA PET/CT 上的淋巴结受累情况是否与短期肿瘤学结果较差相关。
我们回顾性分析了 2015 年至 2020 年间 149 例接受 Ga-PSMA PET/CT 检查的高危局限性或局部区域性前列腺癌患者。所有患者均未接受新辅助或辅助治疗。研究终点为 PSA 持续存在和生化复发。Logistic 回归模型用于识别 PSA 持续存在的术前预测因子。Kaplan-Meier 分析用于估计生化无复发生存率。
在 149 例确定的患者中，19 例（13%）在术前 Ga-PSMA PET/CT 上发现淋巴结受累。Ga-PSMA PET/CT 对识别病理性淋巴结受累的敏感性、特异性和准确性分别为 68%、95%和 92%。PET 阴性淋巴结患者的 PSA 持续存在率低于 PET 阳性淋巴结患者（15%比 84%，p<0.001）。影像学上的阳性淋巴结（OR=41.03，p<0.001）和临床 T2c-T3 期（OR=6.96，p=0.002）与多变量分析中的 PSA 持续存在相关。在 PET 阴性淋巴结患者中，1 年和 2 年的生化无复发生存率分别为 87%和 76%。
术前 Ga-PSMA PET/CT 分期可识别出一组高危前列腺癌患者，在不接受辅助治疗的情况下，根治性前列腺切除术后短期预后良好。未来的研究将评估这些结果在长期随访期间是否持续。
