前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描对前列腺癌原发分期治疗决策的影响：巴西国家公共卫生系统的回顾性分析。

Impact of Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography on the Therapeutic Decision of Prostate Carcinoma Primary Staging: A Retrospective Analysis at the Brazilian National Public Health System.

机构信息

Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.

Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.

出版信息

Ann Surg Oncol. 2023 Jul;30(7):4541-4549. doi: 10.1245/s10434-023-13365-y. Epub 2023 Mar 30.

BACKGROUND

Prostate cancer (PCa) is the most common malignant tumor in males and conventional imaging does not provide accurate primary staging. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) presents superior performance and strongly affects therapeutic choice.

OBJECTIVE

The aim of this study was to evaluate the impact of PSMA PET, compared with conventional imaging methods, on the therapeutic approach in primary staging scenarios in patients with PCa treated at the Brazilian National Public Health System.

METHODS

Overall, 35 patients diagnosed with PCa were evaluated using PSMA after conventional staging imaging with multiparametric magnetic resonance (MMR) and/or total abdominal computed tomography (CT) scan and bone scintigraphy (BS). The PCa extension identified by PET was compared with conventional imaging; staging changes and the management impact were then determined. PET comparison with conventional imaging, staging, and decision-making changes was analyzed using descriptive statistics.

RESULTS

PET revealed local disease (LD) in 15 (42.9%) patients, seminal vesicle invasion (SVI) in 5 (14.3%) patients, pelvic nodal impairment (PNI) in 7 (20%) patients, pelvic and distant nodes in 3 (8.6%) patients, pelvic nodes and bone metastasis in 4 (11.4%) patients, and pelvic and distant nodes and bone metastasis in 1 (2.8%) patient. Staging changes were observed in 60% of patients, with downstaging predominance (76.2%). Volume increase was identified in 11 (31.4%) patients (only 4 related to upstaging, 36.4%). The board changed management decisions for 60% of the patients. The main limitations of this study were the sample size and its retrospective nature.

CONCLUSIONS

PSMA findings changed the management decisions in more than half of the patients, which made the majority eligible for locoregional treatment and avoided unnecessary procedures in the systemic disease scenario.

背景

前列腺癌（PCa）是男性最常见的恶性肿瘤，常规影像学检查无法提供准确的原发分期。前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）具有优异的性能，强烈影响治疗选择。

目的

本研究旨在评估 PSMA PET 与常规影像学方法相比，对在巴西国家公共卫生系统治疗的 PCa 患者的原发分期场景中的治疗方法的影响。

方法

共有 35 例经多参数磁共振（MMR）和/或全腹 CT 扫描和骨闪烁显像（BS）常规分期成像诊断为 PCa 的患者接受了 PSMA 评估。通过 PET 识别的 PCa 扩展与常规成像进行比较，然后确定分期变化和管理影响。使用描述性统计分析 PET 与常规成像、分期和决策变化的比较。

结果

PET 显示 15 例（42.9%）患者存在局部疾病（LD），5 例（14.3%）患者存在精囊侵犯（SVI），7 例（20%）患者存在骨盆淋巴结受累（PNI），3 例（8.6%）患者存在骨盆和远处淋巴结，4 例（11.4%）患者存在骨盆淋巴结和骨转移，1 例（2.8%）患者存在骨盆和远处淋巴结和骨转移。60%的患者出现分期变化，以降期为主（76.2%）。11 例（31.4%）患者的肿瘤体积增加（仅 4 例与升期有关，占 36.4%）。该委员会改变了 60%的患者的管理决策。本研究的主要局限性是样本量和回顾性。