Mori Shunsuke, Kato Taigo, Watabe Tadashi, Hatano Koji, Abe Toyohumi, Fukuhara Shinichiro, Kiuchi Hiroshi, Imamura Ryoichi, Uemura Motohide, Nonomura Norio
Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Osaka, Japan.
Cancer Diagn Progn. 2022 Sep 3;2(5):598-602. doi: 10.21873/cdp.10148. eCollection 2022 Sep-Oct.
BACKGROUND/AIM: Prostate cancer (PC) is one of the most common types of cancer in men worldwide. Most patients with metastatic PC are treated with androgen deprivation therapy (ADT) using luteinizing hormone-releasing hormone agonists and antagonists as first-line therapy. The majority of PC patients develop a castration-resistant PC (CRPC), which eventually leads to high mortality with poor prognosis, despite new targeted therapies. However, given that oligometastatic recurrence may enable local therapy in CRPC, accurate detection of metastatic lesions may improve clinical outcomes in patients with CRPC.
We report the case of an 83-year-old man with CRPC. Fluorine-prostate-specific membrane antigen-1007 positron emission tomography/ computed tomography (F-PSMA-1007 PET/CT) revealed weak physiological PSMA accumulation in the prostate and strong accumulation not only in the internal iliac lymph node but also in the two obturator lymph nodes that could not be detected with conventional CT or magnetic resonance imaging. Prostatic re-biopsy revealed no prostate malignancy. Under the diagnosis of oligometastases in the pelvic lymph nodes, the patient underwent laparoscopic pelvic lymph node dissection, which revealed lymph node metastases in two obturator lymph nodes and the internal iliac lymph node, corresponding to the PSMA accumulation sites. The patient experienced at least 7 months of recurrence-free duration without additional treatment.
This study indicates a novel approach to oligometastatic CRPC by means of accurate staging with F-PSMA-1007 PET/CT.
背景/目的：前列腺癌（PC）是全球男性中最常见的癌症类型之一。大多数转移性PC患者接受以促黄体生成素释放激素激动剂和拮抗剂作为一线治疗的雄激素剥夺疗法（ADT）。尽管有新的靶向治疗方法，但大多数PC患者仍会发展为去势抵抗性前列腺癌（CRPC），最终导致高死亡率和不良预后。然而，鉴于寡转移复发可能使CRPC患者能够接受局部治疗，准确检测转移灶可能会改善CRPC患者的临床结局。
我们报告了一例83岁的CRPC男性患者。氟-前列腺特异性膜抗原-1007正电子发射断层扫描/计算机断层扫描（F-PSMA-1007 PET/CT）显示前列腺中PSMA有微弱的生理性积聚，不仅在髂内淋巴结，而且在两个常规CT或磁共振成像无法检测到的闭孔淋巴结中有强烈积聚。前列腺再次活检未发现前列腺恶性肿瘤。在诊断为盆腔淋巴结寡转移后，患者接受了腹腔镜盆腔淋巴结清扫术，结果显示两个闭孔淋巴结和髂内淋巴结有淋巴结转移，与PSMA积聚部位相对应。患者在未接受额外治疗的情况下至少有7个月的无复发生存期。
本研究表明通过F-PSMA-1007 PET/CT进行准确分期是一种针对寡转移CRPC的新方法。
