Falkenbach Fabian, Ambrosini Francesca, Tennstedt Pierre, Eiber Matthias, Heck Matthias M, Preisser Felix, Graefen Markus, Budäus Lars, Koehler Daniel, Knipper Sophie, Maurer Tobias
Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
Cancers (Basel). 2023 Oct 16;15(20):5008. doi: 10.3390/cancers15205008.
To assess the influence of biochemical recurrence (BCR) risk groups and PSA kinetics on the outcomes of radioguided surgery against prostate-specific membrane antigen (PSMA-RGS). Currently, neither BCR risk group nor PSA doubling time (PSA-DT), or PSA velocity (PSA-V) are actively assigned or relevant for counseling prior to PSMA-RGS.
We retrospectively analyzed PSMA-RGS cases for oligorecurrent prostate cancer between 2014 and 2023. BCR risk groups, PSA-DT, and PSA-V were analyzed as predictors for complete biochemical response (cBR, PSA < 0.2 ng/mL), BCR-free, and therapy-free survival (BCRFS, TFS).
Of 374 included patients, only 21/374 (6%) and 201/374 (54%) were classified as low- and high-risk BCR (no group assignment possible in 152/374, 41%). A total of 13/21 (62%) patients with low- and 120/201 (60%) with high-risk BCR achieved cBR ( = 1.0). BCR classification was no predictor for BCRFS (HR:1.61, CI: 0.70-3.71, = 0.3) or subsequent TFS (HR:1.07, CI: 0.46-2.47, = 0.9). A total of 47/76 (62%) patients with PSA-DT ≤ 6 mo and 50/84 (60%) with PSA-DT > 6 mo achieved cBR ( = 0.4). PSA-DT was not associated with cBR (OR: 0.99, CI: 0.95-1.03, = 0.5), BCRFS (HR: 1.00, CI: 0.97-1.03, = 0.9), or TFS (HR: 1.02, CI: 0.99-1.04, = 0.2). Consistent negative findings were recorded for PSA-V.
The BCR risk groups and PSA kinetics do not predict the oncological success of PSMA-RGS performed at low absolute PSA values. Indolent low-risk BCR is rarely treated by PSMA-RGS.
评估生化复发（BCR）风险分组和前列腺特异性抗原动力学对前列腺特异性膜抗原放射性引导手术（PSMA-RGS）结果的影响。目前，在PSMA-RGS之前，BCR风险分组、前列腺特异性抗原倍增时间（PSA-DT）或前列腺特异性抗原速率（PSA-V）均未被积极应用于指导咨询或与之相关。
我们回顾性分析了2014年至2023年间寡转移性前列腺癌的PSMA-RGS病例。分析BCR风险分组、PSA-DT和PSA-V作为完全生化缓解（cBR，PSA<0.2 ng/mL）、无BCR及无治疗生存期（BCRFS，TFS）的预测指标。
在纳入的374例患者中，仅21/374（6%）和201/374（54%）被分类为低风险和高风险BCR（152/374，41%无法分组）。共有13/21（62%）例低风险BCR患者和120/201（60%）例高风险BCR患者实现了cBR（P=1.0）。BCR分类不是BCRFS（风险比：1.61，可信区间：0.70-3.71，P=0.3）或后续TFS（风险比：1.07，可信区间：0.46-2.47，P=0.9）的预测指标。共有47/76（62%）例PSA-DT≤6个月的患者和50/84（60%）例PSA-DT>6个月的患者实现了cBR（P=0.4）。PSA-DT与cBR（比值比：0.99，可信区间：0.95-1.03，P=0.5）、BCRFS（风险比：1.00，可信区间：0.97-1.03，P=0.9）或TFS（风险比：1.02，可信区间：0.99-1.04，P=0.2）均无关。PSA-V也得到了一致的阴性结果。
BCR风险分组和PSA动力学不能预测在低绝对PSA值时进行的PSMA-RGS的肿瘤学疗效。惰性低风险BCR很少通过PSMA-RGS治疗。
