From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.).
Radiographics. 2023 Dec;43(12):e230112. doi: 10.1148/rg.230112.
Prostate cancer may recur several years after definitive treatment, such as prostatectomy or radiation therapy. A rise in serum prostate-specific antigen (PSA) level is the first sign of disease recurrence, and this is termed . Patients with biochemical recurrence have worse survival outcomes. Radiologic localization of recurrent disease helps in directing patient management, which may vary from active surveillance to salvage radiation therapy, androgen-deprivation therapy, or other forms of systemic and local therapy. The likelihood of detecting the site of recurrence increases with higher serum PSA level. MRI provides optimal diagnostic performance for evaluation of the prostatectomy bed. Prostate-specific membrane antigen (PSMA) PET radiotracers currently approved by the U.S. Food and Drug Administration demonstrate physiologic urinary excretion, which can obscure recurrence at the vesicourethral junction. However, MRI and PSMA PET/CT have comparable diagnostic performance for evaluation of local recurrence after external-beam radiation therapy or brachytherapy. PSMA PET/CT outperforms MRI in identifying recurrence involving the lymph nodes and bones. Caveats for use of both PSMA PET/CT and MRI do exist and may cause false-positive or false-negative results. Hence, these techniques have complementary roles and should be interpreted in conjunction with each other, taking the patient history and results of any additional prior imaging studies into account. Novel PSMA agents at various stages of investigation are being developed, and preliminary data show promising results; these agents may revolutionize the landscape of prostate cancer recurrence imaging in the future. RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. See the invited commentary by Turkbey in this issue. The slide presentation from the RSNA Annual Meeting is available for this article.
前列腺癌根治性治疗（如前列腺切除术或放射治疗）后数年可能会复发。血清前列腺特异性抗原（PSA）水平升高是疾病复发的第一个迹象，称为生化复发。生化复发患者的生存结局更差。复发病灶的影像学定位有助于指导患者管理，管理方法可能从主动监测到挽救性放射治疗、雄激素剥夺治疗或其他形式的全身和局部治疗不等。随着血清 PSA 水平的升高，检测复发部位的可能性增加。磁共振成像（MRI）为评估前列腺切除术床提供了最佳的诊断性能。目前美国食品和药物管理局（FDA）批准的前列腺特异性膜抗原（PSMA）PET 放射性示踪剂表现出生理性的尿排泄，这可能会掩盖膀胱尿道交界处的复发。然而，对于外照射或近距离放射治疗后局部复发的评估，MRI 和 PSMA PET/CT 具有相当的诊断性能。PSMA PET/CT 在识别涉及淋巴结和骨骼的复发方面优于 MRI。PSMA PET/CT 和 MRI 的使用均存在注意事项，可能导致假阳性或假阴性结果。因此，这些技术具有互补作用，应相互结合，同时考虑患者病史和任何其他先前影像学研究的结果。正在开发处于不同研究阶段的新型 PSMA 药物，初步数据显示出有前景的结果；这些药物可能会在未来彻底改变前列腺癌复发成像的格局。RSNA，2023 本文的测验问题可通过在线学习中心获取。请参阅本期 Turkbey 的特邀评论。本文的 RSNA 年会幻灯片演示可在本文中获取。
