Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands.
Department of Nuclear Medicine, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands.
Eur Urol Oncol. 2024 Apr;7(2):204-210. doi: 10.1016/j.euo.2023.05.004. Epub 2023 Jun 7.
The use of clinical parameters, including prebiopsy magnetic resonance imaging (MRI), to decide between active surveillance (AS) and active therapy for prostate cancer (PCa) leads to imperfect selection. Additional prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) imaging may improve risk stratification.
To study risk stratification and patient selection for AS with the addition of PSMA PET/CT to standard practice.
DESIGN, SETTING, AND PARTICIPANTS: A single-centre prospective cohort study (NL69880.100.19) enrolled patients recently diagnosed with PCa who started AS. At diagnosis, all participants had undergone prebiopsy MRI and targeted biopsy for visualised lesions. Patients underwent an additional [68Ga]-PSMA PET/CT and targeted biopsy of all PSMA lesions with a maximum standardised uptake value (SUVmax) of ≥4 not covered by previous biopsies.
The primary outcome was the number needed to scan (NNS) to detect one patient with upgrading. The study was powered to detect an NNS of 10. Regarding secondary outcomes, univariate logistic regressions analyses were performed on all patients and on the patients who received additional PSMA targeted biopsies on the likelihood of upgrading.
A total of 141 patients were included. Additional PSMA targeted biopsies were performed in 45 (32%) patients. In 13 (9%) patients, upgrading was detected: nine grade group (GG) 2, two GG 3, one GG 4, and one GG 5. The NNS was 11 (95% confidence interval 6-18). Of all participants, PSMA PET/CT and targeted biopsies yielded upgrading most frequently in patients with negative MRI (Prostate Imaging Reporting and Data System [PI-RADS] 1-2). Of patients who received additional PSMA targeted biopsies, upgrading was most frequently found in those with higher prostate-specific antigen density and negative MRI. Limitations included the lack of comparison with standard repeat biopsy, no central review of MRI, and possibility of biopsy sampling error.
PSMA PET/CT can further improve PCa risk stratification and selection for AS patients diagnosed after MRI and targeted biopsies.
Prostate-specific membrane antigen positron emission tomography/computed tomography and additional targeted prostate biopsies can identify more aggressive prostate cancer cases previously missed in patients recently started with expectant management for favourable-risk prostate cancer.
使用临床参数，包括活检前磁共振成像（MRI），来决定前列腺癌（PCa）的主动监测（AS）和主动治疗，这种方法的选择并不完美。额外的前列腺特异性膜抗原（PSMA）正电子发射断层扫描/计算机断层扫描（PET/CT）成像可能会改善风险分层。
研究在标准实践中增加 PSMA PET/CT 对 AS 进行风险分层和患者选择的效果。
设计、地点和参与者：这是一项单中心前瞻性队列研究（NL69880.100.19），招募了最近被诊断为 PCa 并开始 AS 的患者。在诊断时，所有患者均接受了活检前 MRI 和针对可见病变的靶向活检。患者接受了额外的 [68Ga]-PSMA PET/CT 检查，并对所有 PSMA 病变进行靶向活检，这些病变的最大标准化摄取值（SUVmax）≥4，且未被之前的活检覆盖。
主要结局是检测到一名升级患者所需的扫描次数（NNS）。该研究的目的是检测 NNS 为 10。关于次要结局，对所有患者和接受额外 PSMA 靶向活检的患者进行了单变量逻辑回归分析，以评估升级的可能性。
共纳入 141 例患者。45 例（32%）患者接受了额外的 PSMA 靶向活检。在 13 例（9%）患者中发现了升级：9 例为 GG2，2 例为 GG3，1 例为 GG4，1 例为 GG5。NNS 为 11（95%置信区间 6-18）。在所有参与者中，PSMA PET/CT 和靶向活检在 MRI 阴性（前列腺成像报告和数据系统[PI-RADS]1-2）的患者中最常导致升级。在接受额外 PSMA 靶向活检的患者中，前列腺特异性抗原密度较高且 MRI 阴性的患者中最常发现升级。局限性包括缺乏与标准重复活检的比较、MRI 无中心审查以及活检采样误差的可能性。
PSMA PET/CT 可进一步改善 MRI 和靶向活检后诊断为 PCa 的 AS 患者的风险分层和选择。
前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描和额外的靶向前列腺活检可以识别出以前在接受有利风险前列腺癌期待管理的患者中错过的更具侵袭性的前列腺癌病例。
