Bergamini Marco, Dalla Volta Alberto, Caramella Irene, Bercich Luisa, Fisogni Simona, Bertoli Mattia, Valcamonico Francesca, Grisanti Salvatore, Poliani Pietro Luigi, Bertagna Francesco, Berruti Alfredo
Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy.
Department of Molecular and Translational Medicine, Pathology Unit, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy.
Front Oncol. 2022 Jul 22;12:937713. doi: 10.3389/fonc.2022.937713. eCollection 2022.
The development of a neuroendocrine phenotype as a mechanism of resistance to hormonal treatment is observed in up to 20% of advanced prostate cancer patients. High grade neuroendocrine prostate cancer (NEPC) is associated to poor prognosis and the therapeutic armamentarium is restricted to platinum-based chemotherapy. Prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) imaging has recently emerged as a potential new standard for the staging of prostate cancer and PSMA-based radioligand therapy (RLT) as a therapeutic option in advanced metastatic castration resistant prostate cancer (mCRPC). PSMA-based theranostic is not currently applied in the staging and treatment of NEPC since PSMA expression on neuroendocrine differentiated cells was shown to be lost. In this case series, we present 3 consecutive mCRPC patients with histologically proven high grade neuroendocrine differentiation who underwent PSMA-PET/CT and surprisingly showed high tracer uptake. This observation stimulates further research on the use of PSMA-based theranostic in the management of NEPC.
在高达20%的晚期前列腺癌患者中观察到神经内分泌表型的发展是激素治疗耐药的一种机制。高级别神经内分泌前列腺癌（NEPC）与预后不良相关，其治疗手段仅限于铂类化疗。基于前列腺特异性膜抗原（PSMA）的正电子发射断层扫描（PET）/计算机断层扫描（CT）成像最近已成为前列腺癌分期的潜在新标准，基于PSMA的放射性配体疗法（RLT）作为晚期转移性去势抵抗性前列腺癌（mCRPC）的一种治疗选择。基于PSMA的诊疗目前未应用于NEPC的分期和治疗，因为神经内分泌分化细胞上的PSMA表达已被证明丧失。在这个病例系列中，我们展示了3例经组织学证实为高级别神经内分泌分化的连续mCRPC患者，他们接受了PSMA-PET/CT检查，令人惊讶的是显示出高示踪剂摄取。这一观察结果激发了对基于PSMA的诊疗在NEPC管理中的应用的进一步研究。
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