Laboratory of Genitourinary Cancer Pathogenesis, National Cancer Institute, NIH, Bethesda, Maryland.
Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland.
J Urol. 2022 Jul;208(1):90-99. doi: 10.1097/JU.0000000000002492. Epub 2022 Mar 1.
Neoadjuvant intense androgen deprivation therapy (iADT) can exert a wide range of histological responses, which in turn are reflected in the final prostatectomy specimen. Accurate identification and measurement of residual tumor volumes are critical for tracking and stratifying patient outcomes.
The goal of this current study was to evaluate the ability of antibodies against prostate-specific membrane antigen (PSMA) to specifically detect residual tumor in a cohort of 35 patients treated with iADT plus enzalutamide for 6 months prior to radical prostatectomy.
Residual carcinoma was detected in 31 patients, and PSMA reacted positively with tumor in all cases. PSMA staining was 96% sensitive for tumor, with approximately 82% of benign regions showing no reactivity. By contrast, PSMA positively reacted with 72% of benign regions in a control cohort of 37 untreated cases, resulting in 28% specificity for tumor. PSMA further identified highly dedifferentiated prostate carcinomas including tumors with evidence of neuroendocrine differentiation.
We propose that anti-PSMA immunostaining be a standardized marker for identifying residual cancer in the setting of iADT.
新辅助强化雄激素剥夺疗法（iADT）可引起广泛的组织学反应，这些反应继而反映在最终的前列腺切除术标本中。准确识别和测量残留肿瘤体积对于跟踪和分层患者结局至关重要。
本研究的目的是评估针对前列腺特异性膜抗原（PSMA）的抗体在 35 例接受 iADT 加恩扎鲁胺治疗 6 个月后行根治性前列腺切除术患者队列中检测残留肿瘤的能力。
在 31 例患者中检测到残留癌，PSMA 在所有病例中均与肿瘤呈阳性反应。PSMA 染色对肿瘤的敏感性为 96%，约 82%的良性区域无反应。相比之下，PSMA 在未经治疗的 37 例对照队列的 72%良性区域呈阳性反应，导致肿瘤的特异性为 28%。PSMA 进一步鉴定了高度去分化的前列腺癌，包括具有神经内分泌分化证据的肿瘤。
我们建议抗 PSMA 免疫染色成为 iADT 环境中识别残留癌的标准化标志物。
