Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
Institute of Urology, Nanjing University, Nanjing, China.
J Nucl Med. 2023 Oct;64(10):1550-1555. doi: 10.2967/jnumed.122.265368. Epub 2023 Jul 20.
Our previous study found that the prostate-specific membrane antigen (PSMA) PET/CT response of primary prostate cancer (PCa) to neoadjuvant therapy can predict the pathologic response. This study was designed to investigate the association between [Ga]PSMA PET/CT changes and biochemical progression-free survival (bPFS) in high-risk patients who underwent neoadjuvant therapy before radical prostatectomy (RP). Seventy-five patients with high-risk PCa in 2 phase II clinical trials who received neoadjuvant therapy before RP were included. The patients received androgen deprivation therapy plus docetaxel ( = 33) or androgen deprivation therapy plus abiraterone ( = 42) as neoadjuvant treatment. All patients had serial [Ga]PSMA PET/CT scans before and after neoadjuvant therapy. Age, initial prostate-specific antigen level, nadir prostate-specific antigen level before RP, tumor grade at biopsy, treatment regimen, clinical T stage, PET imaging features, pathologic N stage, and pathologic response on final pathology were included for univariate and multivariate Cox regression analyses to identify independent predictors of bPFS. With a median follow-up of 30 mo, 18 patients (24%) experienced biochemical progression. Multivariate Cox regression analyses revealed that only SUV derived from posttreatment [Ga]PSMA PET/CT and pathologic response on final pathology were independent factors for the prediction of bPFS, with hazard ratios of 1.02 (95% CI, 1.00-1.04; = 0.02) and 0.12 (95% CI, 0.02-0.98; = 0.048), respectively. Kaplan-Meier analysis revealed that patients with a favorable [Ga]PSMA PET/CT response (posttreatment SUV < 8.5) or a favorable pathologic response (pathologic complete response or minimal residual disease) had a significantly lower rate of 3-y biochemical progression. Our results indicated that [Ga]PSMA PET/CT response was an independent risk factor for the prediction of bPFS in patients with high-risk PCa receiving neoadjuvant therapy and RP, suggesting [Ga]PSMA PET/CT to be an ideal tool to monitor response to neoadjuvant therapy.
我们之前的研究发现，原发性前列腺癌（PCa）接受新辅助治疗后的前列腺特异性膜抗原（PSMA）PET/CT 反应可预测病理反应。本研究旨在探讨新辅助治疗前接受根治性前列腺切除术（RP）的高危患者中，[Ga]PSMA PET/CT 变化与生化无进展生存期（bPFS）之间的关系。
在 2 项 II 期临床试验中，共纳入了 75 例接受新辅助治疗前 RP 的高危 PCa 患者。患者接受雄激素剥夺治疗联合多西他赛（n = 33）或雄激素剥夺治疗联合阿比特龙（n = 42）作为新辅助治疗。所有患者均在新辅助治疗前后接受了连续的[Ga]PSMA PET/CT 扫描。年龄、初始前列腺特异性抗原水平、RP 前最低前列腺特异性抗原水平、活检时肿瘤分级、治疗方案、临床 T 分期、PET 成像特征、病理 N 分期和最终病理的病理反应均纳入单因素和多因素 Cox 回归分析，以确定 bPFS 的独立预测因素。
中位随访 30 个月后，18 例（24%）患者发生生化进展。多因素 Cox 回归分析显示，仅治疗后[Ga]PSMA PET/CT 的 SUV 最大值和最终病理的病理反应是 bPFS 的独立预测因素，风险比分别为 1.02（95%CI，1.00-1.04；P = 0.02）和 0.12（95%CI，0.02-0.98；P = 0.048）。Kaplan-Meier 分析显示，治疗后[Ga]PSMA PET/CT 反应良好（SUV < 8.5）或病理反应良好（病理完全缓解或微小残留疾病）的患者，3 年生化进展率显著较低。
我们的研究结果表明，[Ga]PSMA PET/CT 反应是接受新辅助治疗和 RP 的高危 PCa 患者 bPFS 的独立预测因素，提示[Ga]PSMA PET/CT 是监测新辅助治疗反应的理想工具。
