Department of Radiology, McMaster University, Hamilton, ON, Canada.
Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital; University of Toronto, Toronto, ON, Canada.
Prostate Cancer Prostatic Dis. 2023 Jun;26(2):240-248. doi: 10.1038/s41391-022-00544-3. Epub 2022 Apr 19.
Prostate-specific membrane antigen (PSMA) PET is highly sensitive in identifying disease recurrence in men with biochemical recurrence of prostate cancer (BCR) after primary therapy and is rapidly being adopted in clinical practice. The purpose of this systematic review and meta-analysis was to assess the documented impact of PSMA-PET on patient management and outcomes, including prostate-specific antigen (PSA) response, and intermediate and long-term outcome measures.
MBASE, PubMed, Web of Science, Cochrane and OVID databases were searched for studies reporting on the impact of PSMA-PET on the management and outcomes of patients with BCR after definitive primary therapy. Outcome measures assessed included biochemical response to therapy after PET and BCR-free survival (BRFS). The proportions of patients in whom management changed, and the proportion of patients in whom each outcome measure was obtained were tabulated and pooled into meta-analysis using DerSimonian-Laird method.
A total of 34 studies with 3680 men reported change in management after PSMA-PET and 27 studies with 2639 men reported on at least one outcome measure and had follow-up data. PSMA-PET was positive in 2508/3680 (68.2%). The pooled proportion of change in management after PSMA-PET was 56.4% (95% CI, 48.0-63.9%). A decrease in serum PSA was documented in 72.4% of men (95% CI, 63.4-81.5%), and complete biochemical response in 23.3% (95% CI, 14.6-32.0%) at a median follow-up of 8.1 and 11 months, respectively. The pooled BRFS rate was 60.2% (95% CI, 49.1-71.4%) at a median follow-up of 20 months.
In conclusion, PSMA PET is positive in more than 2/3 of men with BCR and impacts patient management in more than half of the men. BRFS after PET-directed management is 60% at a median of 20 months after salvage therapy, and complete biochemical response may be achieved in up to a quarter of men.
前列腺特异性膜抗原（PSMA）PET 在识别原发性治疗后生化复发（BCR）的男性疾病复发方面具有高度敏感性，并且在临床实践中迅速得到采用。本系统评价和荟萃分析的目的是评估 PSMA-PET 对患者管理和结果的记录影响，包括前列腺特异性抗原（PSA）反应以及中期和长期结果测量。
在 MBASE、PubMed、Web of Science、Cochrane 和 OVID 数据库中搜索报告 PSMA-PET 对明确原发性治疗后 BCR 患者管理和结果影响的研究。评估的结果测量包括 PET 后治疗的生化反应和 BCR 无复发生存（BRFS）。记录管理发生变化的患者比例以及获得每个结果测量的患者比例，并使用 DerSimonian-Laird 方法将其汇总到荟萃分析中。
共有 34 项研究（3680 名男性）报告了 PSMA-PET 后管理的变化，27 项研究（2639 名男性）报告了至少一项结果测量并具有随访数据。PSMA-PET 阳性率为 2508/3680（68.2%）。PSMA-PET 后管理变化的汇总比例为 56.4%（95%CI，48.0-63.9%）。72.4%（95%CI，63.4-81.5%）的男性血清 PSA 下降，23.3%（95%CI，14.6-32.0%）完全生化反应，中位数随访分别为 8.1 和 11 个月。PSMA-PET 指导管理后的汇总 BRFS 率为 60.2%（95%CI，49.1-71.4%），中位数随访时间为 20 个月。
总之，BCR 男性中超过 2/3 的男性 PSMA PET 呈阳性，超过一半的男性的治疗管理受到影响。PET 指导治疗后 20 个月的 BRFS 中位数为 60%，多达四分之一的男性可能实现完全生化缓解。
