IRCCS Ospedale San Raffaele, Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute.
Vita-Salute San Raffaele University, Milan, Italy.
Curr Opin Urol. 2024 Jul 1;34(4):294-299. doi: 10.1097/MOU.0000000000001180. Epub 2024 Apr 5.
The implementation of PET with prostate-specific membrane antigen (PSMA) tracer as primary staging tool occurred recently. Since its introduction, a novel category of patients emerged, with negative staging at conventional imaging, and positive molecular imaging. Local treatment in these patients might be associated with improved oncological outcomes when combined with systemic therapy. However, its impact on oligometastatic prostate cancer (omPCa) remains unknown. In this review, we aimed at investigating the role of cytoreductive radical prostatectomy (cRP) in oligometastatic disease at molecular imaging.
After comprehensive review of literature, two retrospective studies highlighted the feasibility, safety, and potential benefits of surgery in omPCA patients at molecular imaging. They showed that 72% of patients achieved PSA less than 0.01 ng/ml following cRP as part of a multimodal approach, 17% experienced radiographic progression, and 7% died at 27-month median follow-up. Moreover, complications postcRP after PSMA PET were modest, with a 40% rate of any adverse event, and 5% of grade more than 3. The 1-year urinary continence after cRP rate was 82%. The oncological, functional outcomes and the complication rate aligned with those observed in series of cRP after conventional imaging.
cRP is feasible, well tolerated, and effective in selected patients with omPCa at PSMA PET.
最近，前列腺特异性膜抗原 (PSMA) 示踪剂的 PET 已被用于作为初始分期工具。自引入以来，出现了一类新的患者，他们在常规影像学检查时分期为阴性，但在分子影像学检查时为阳性。这些患者在接受局部治疗时，如果与系统治疗相结合，可能会获得更好的肿瘤学结果。然而，其在寡转移前列腺癌 (omPCa) 中的作用仍不清楚。在这篇综述中，我们旨在研究在分子影像学中，去势性前列腺切除术 (cRP) 在寡转移疾病中的作用。
在对文献进行全面回顾后，两项回顾性研究强调了在分子影像学中对 omPCA 患者进行手术的可行性、安全性和潜在获益。结果表明，在多模式治疗中，72%的患者在 cRP 后 PSA 降至 0.01ng/ml 以下，17%的患者出现影像学进展，7%的患者在 27 个月的中位随访中死亡。此外，PSMA PET 后行 cRP 的并发症发生率适中，总不良事件发生率为 40%，3 级以上并发症发生率为 5%。cRP 后 1 年尿控率为 82%。其肿瘤学、功能结果和并发症发生率与在常规影像学系列中观察到的结果一致。
在 PSMA PET 检查中，cRP 对于选择的 omPCa 患者是可行的、耐受良好的，并且是有效的。
