Falkenbach Fabian, Schmalhofer Marie-Lena, Tian Zhe, Mazzucato Giovanni, Karakiewicz Pierre I, Graefen Markus, Knipper Sophie, Budäus Lars, Koehler Daniel, Maurer Tobias
Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montréal Health Center, Montréal, Québec, Canada.
Prostate. 2025 Jan;85(1):105-111. doi: 10.1002/pros.24806. Epub 2024 Oct 9.
To evaluate how prostate-specific antigen (PSA) levels decrease after removal of isolated prostate cancer (PCa) nodal metastases in relation to their diameter/volume ("PSA-density of PCa-metastases") and maximum standardized uptake value (SUV).
A total of 83 consecutive patients with solitary nodal recurrence after radical prostatectomy who underwent prostate-specific membrane antigen-radioguided salvage surgery were retrospectively analyzed. Using multivariable linear regression models, the PSA-decrease after removal of each PCa-metastases (=PSA-contribution of each PCa-metastases) was correlated with the long axis diameter/estimated volume and the SUV of each removed metastasis. Sizes were measured by imaging and histopathologic examination.
A total of 83 patients were included with a median (interquartile range [IQR]) PSA-decrease of 0.56 [0.22, 1.31] ng/mL after salvage surgery. The median [IQR] long axis diameters in imaging and histopathological examination were 8.0 [6.0, 11.0] mm and 8.4 [5.5, 11.1] mm, respectively. The median [IQR] estimated volumes were 0.13 [0.05, 0.32] cc (imaging) and 0.05 [0.02, 0.17] cc (pathology). In multivariable linear regression analyses, the estimated PSA-contribution ([95% confidence interval [CI]) of each millimeter of long axis diameter was 0.09 [0.03, 0.14] ng/mL (imaging) or 0.08 [0.03, 0.12] ng/mL (histology). The minimum diameter for biochemical recurrence (PSA ≥ 0.2 ng/mL) was >2.2 mm (imaging) or >2.5 mm (histology). The estimated PSA-contribution [95% CI] of each cc cancer volume was 1.23 [0.51, 1.94] ng/mL (imaging) or 1.46 [0.40, 2.52] ng/mL (histology). SUV as surrogate parameter for tissue composition was associated with increased PSA-contribution of PCa-metastases (+0.03-0.05 ng/mL per unit increase).
The diameter/volume and SUV of metastatic tissue correlate with its contribution to PSA levels. Therefore, very small metastases may produce too little PSA for biochemical recurrence.
评估孤立性前列腺癌（PCa）淋巴结转移灶切除后前列腺特异性抗原（PSA）水平下降情况与其直径/体积（“PCa转移灶的PSA密度”）及最大标准化摄取值（SUV）之间的关系。
对83例根治性前列腺切除术后出现孤立性淋巴结复发并接受前列腺特异性膜抗原放射性引导挽救性手术的连续患者进行回顾性分析。使用多变量线性回归模型，将每个PCa转移灶切除后的PSA下降值（=每个PCa转移灶的PSA贡献值）与每个切除转移灶的长轴直径/估计体积及SUV进行关联分析。通过影像学和组织病理学检查测量大小。
共纳入83例患者，挽救性手术后PSA下降的中位数（四分位间距[IQR]）为0.56[0.22，1.31]ng/mL。影像学和组织病理学检查中长轴直径的中位数[IQR]分别为8.0[6.0，11.0]mm和8.4[5.5，11.1]mm。估计体积的中位数[IQR]分别为0.13[0.05，0.32]cc（影像学）和0.05[0.02，0.17]cc（病理学）。在多变量线性回归分析中，长轴直径每增加1毫米的估计PSA贡献值（[95%置信区间[CI]]）为0.09[0.03，0.14]ng/mL（影像学）或0.08[0.03，0.12]ng/mL（组织学）。生化复发（PSA≥0.2ng/mL）的最小直径在影像学上>2.2mm，在组织学上>2.5mm。每立方厘米癌体积的估计PSA贡献值[95%CI]为1.23[0.51，1.94]ng/mL（影像学）或1.46[0.40，2.52]ng/mL（组织学）。作为组织成分替代参数的SUV与PCa转移灶的PSA贡献增加相关（每单位增加+0.03 - 0.05ng/mL）。
转移组织的直径/体积及SUV与其对PSA水平的贡献相关。因此，非常小的转移灶可能产生的PSA过少而不足以导致生化复发。
