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前列腺癌根治性前列腺切除术后生化复发的 PET/CT 表现及对患者疾病管理的影响的叙述性综述:前列腺癌根治性前列腺切除术后生化复发的 PET/CT 表现及对患者疾病管理的影响的叙述性综述。

Narrative review of PET/CT performances at biochemical recurrence in prostate cancer after radical prostatectomy and impact on patient disease management: Revue narrative à propos des performances de la TEP/TDM en cas de récidive biochimique après prostatectomie radicale dans le cancer de la prostate et impact sur la prise en charge des patients.

机构信息

Department of Medical oncology, Institut Bergonié, Bordeaux.

Department of Radiation Oncology, Institut Bergonié, Bordeaux.

出版信息

Prog Urol. 2022 Jun;32(6S1):6S33-6S42. doi: 10.1016/S1166-7087(22)00173-7.

Abstract

Patients treated by radical prostatectomy (RP) for localized prostate cancer (PCa) may experience biochemical recurrence (BCR) in approximately 30% of cases. Recently, advances in imaging modalities and in particular Positron-Emission Tomography with computed tomography (PET/CT) imaging allow for better detection and characterization of lesions outside the prostatic bed at recurrence. Thus, treatment at BCR can be significantly improved by a tailored strategy based on new generation imaging. A more precise and accurate staging of the disease at recurrence paves the way to more appropriate treatment, potentially translating into better survival outcomes of these patients. This review therefore highlights the interest of PET/CT at the time of BCR, its superiority over standard imaging in terms of staging, and its impact on guiding the different therapeutic possibilities depending on the site, number, and volumes of recurrence. Indeed, we will discuss below about different strategies and their indications: salvage radiotherapy of the prostate bed, systemic therapies, stereotactic body radiotherapy and others therapeutical strategies. The various innovative approaches based on PET/CT implementation are partly underway within protocol trials to prove their benefits on clinically meaningful endpoints. © 2022 Elsevier Masson SAS. All rights reserved.

摘要

接受根治性前列腺切除术(RP)治疗局限性前列腺癌(PCa)的患者中,约有 30%会出现生化复发(BCR)。最近,影像学手段的进步,特别是正电子发射断层扫描结合计算机断层扫描(PET/CT)成像,使前列腺床外复发病灶的检测和特征分析得到改善。因此,基于新一代影像学的个体化治疗策略可以显著改善 BCR 时的治疗效果。在复发时对疾病进行更精确和准确的分期为更合适的治疗铺平了道路,可能会为这些患者带来更好的生存结果。因此,本文重点介绍了 BCR 时 PET/CT 的应用价值,其在分期方面优于标准影像学检查,以及其对指导不同治疗方法的影响,包括复发部位、数量和体积。实际上,我们将在下文讨论不同的策略及其适应证:前列腺床挽救性放疗、全身治疗、立体定向体部放疗和其他治疗策略。部分基于 PET/CT 应用的创新方法正在协议试验中进行,以证明其在有临床意义的终点上的获益。 © 2022 Elsevier Masson SAS. All rights reserved.

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