From the Department of Radiation Oncology, Adana Dr Turgut Noyan Research and Treatment Center, Faculty of Medicine, Baskent University, Adana, Turkey.
Department of Radiation Oncology, Gazi University Faculty of Medicine, Ankara, Turkey.
Clin Nucl Med. 2024 Aug 1;49(8):e383-e389. doi: 10.1097/RLU.0000000000005284. Epub 2024 May 31.
We investigated the impact of prostate-specific membrane antigen (PSMA) PET/CT compared with conventional imaging on treatment outcomes for node-positive prostate cancer (PCa) patients who underwent androgen deprivation therapy (ADT) and external radiotherapy (RT).
A multicentric, retrospective study recruited patients with node-positive PCa patients who underwent conventional radiological evaluation or PSMA PET/CT and received ADT and RT at 3 hospitals from 2009 to 2021 were enrolled. Patients underwent prostate and pelvis RT, accompanied by a minimum of 6 months of ADT. The primary endpoints were progression-free survival (PFS) and PCa-specific survival (PCSS). Cox regression analyzed the association of survival with potential prognostic factors, whereas logistic regression identified the predictors of bone and lymph node metastasis.
The median follow-up time was 64.0 months. The majority of patients (64.1%) underwent PSMA PET/CT for staging. The 5-year rates of PFS and PCSS were 63.7% and 83.7%, respectively. Disease progression was observed in 90 patients (36.3%). In multivariable analysis, ADT duration of less than 24 months and post-RT prostate-specific antigen (PSA) nadir were prognostic for PFS. Early clinical T stage and PSMA PET/CT predicted better PCSS. Patients staged with PSMA PET/CT had exhibited significantly higher 5-year PCSS rates than compared with those staged with conventional imaging (95.1% vs 76.9%; P = 0.01). Shorter ADT duration and higher PSA levels after RT independently predicted bone metastasis in multivariable logistic regression. Advanced T stage, shorter ADT duration, and higher PSA levels after neoadjuvant ADT predicted nonregional lymph node recurrence.
ADT with pelvis RT is an effective treatment option for node-positive PCa patients. The PSMA PET/CT outperformed conventional imaging in PCSS, emphasizing the importance of precise clinical staging for patients undergoing definitive RT.
我们研究了前列腺特异性膜抗原（PSMA）PET/CT 与常规影像学检查对接受雄激素剥夺治疗（ADT）和外部放疗（RT）的淋巴结阳性前列腺癌（PCa）患者的治疗结果的影响。
一项多中心、回顾性研究招募了 2009 年至 2021 年期间在 3 家医院接受常规影像学评估或 PSMA PET/CT 检查并接受 ADT 和 RT 的淋巴结阳性 PCa 患者。患者接受前列腺和骨盆 RT，同时接受至少 6 个月的 ADT。主要终点是无进展生存期（PFS）和前列腺癌特异性生存期（PCSS）。Cox 回归分析了生存与潜在预后因素的关系，而逻辑回归确定了骨转移和淋巴结转移的预测因素。
中位随访时间为 64.0 个月。大多数患者（64.1%）接受 PSMA PET/CT 进行分期。5 年 PFS 和 PCSS 率分别为 63.7%和 83.7%。90 例患者（36.3%）发生疾病进展。多变量分析显示，ADT 持续时间小于 24 个月和 RT 后前列腺特异性抗原（PSA）最低值是 PFS 的预后因素。早期临床 T 期和 PSMA PET/CT 预测 PCSS 更好。接受 PSMA PET/CT 分期的患者 5 年 PCSS 率显著高于接受常规影像学分期的患者（95.1% vs 76.9%；P = 0.01）。多变量逻辑回归显示，ADT 持续时间较短和 RT 后 PSA 水平较高独立预测骨转移。晚期 T 期、ADT 持续时间较短和新辅助 ADT 后 PSA 水平较高预测非区域性淋巴结复发。
ADT 联合骨盆 RT 是淋巴结阳性 PCa 患者的有效治疗选择。PSMA PET/CT 在 PCSS 方面优于常规影像学检查，强调了对接受确定性 RT 的患者进行精确临床分期的重要性。
