Ettema Rosemarijn H, Mellema Jan-Jaap J, Meijer Dennie, Oudshoorn Frederik H K, Luining Wietske I, van Leeuwen Pim J, van der Poel Henk G, Donswijk Maarten L, van der Gaag Suzanne, Lam Marnix G E H, Oprea-Lager Daniela E, van den Bergh Roderick C N, Vis André N
Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands; Prostate Cancer Network the Netherlands, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands; Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Department of Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
Eur Urol Oncol. 2025 Jun;8(3):739-746. doi: 10.1016/j.euo.2024.11.003. Epub 2024 Dec 17.
Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is increasingly used for primary staging in prostate cancer. Owing to accurate detection of small metastases on PSMA-PET/CT, patient selection for robot-assisted radical prostatectomy (RARP) has likely changed. This study analyzes oncological outcomes in patients undergoing RARP and extended pelvic lymph node dissection (ePLND) after PSMA-PET/CT staging, compared with those without PSMA-PET/CT.
Patients who underwent staging with PSMA-PET/CT before RARP and ePLND ("PSMA cohort"; 2016-2021) were compared with patients staged without PSMA-PET/CT ("historical cohort"; 2013-2016). Propensity score matching using preoperative variables was performed to limit confounding. As primary outcome measure of biochemical recurrence (BCR)-free survival (BFS) was analyzed, with BCR defined as a prostate specific antigen value of ≥0.2 ng/ml or start of additional therapy after surgery.
After matching, 880 patients were included (440 in each cohort). The median follow-up was 35 mo (interquartile range 21-60) for the entire cohort. In the PSMA cohort, 126/440 patients (29%) experienced BCR versus 205/440 (47%) in the historical cohort (log-rank test p = 0.032). A multivariable Cox regression analysis showed an independent effect of preoperative PSMA-PET/CT staging on BFS (hazard ratio 0.70, 95% confidence interval 0.55-0.89, p = 0.0030).
Patients who underwent staging with PSMA-PET/CT had longer biochemical progression-free survival after RARP and ePLND than those without PSMA-PET/CT. This suggests that PSMA-PET/CT staging alters patient selection for RARP and ePLND, and is associated with improved early oncological outcomes for patients who still undergo surgery.
Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) at the diagnosis of prostate cancer leads to better visualization of metastases and therefore better selection of prostate cancer patients for surgery. Patients who underwent a PSMA-PET/CT scan at the time of diagnosis showed improved oncological outcomes, including longer progression-free survival and less prostate-specific antigen persistence after surgery.
前列腺特异性膜抗原（PSMA）正电子发射断层扫描/计算机断层扫描（PET/CT）越来越多地用于前列腺癌的初始分期。由于PSMA-PET/CT能准确检测小转移灶，机器人辅助根治性前列腺切除术（RARP）的患者选择可能已发生变化。本研究分析了在PSMA-PET/CT分期后接受RARP和扩大盆腔淋巴结清扫术（ePLND）的患者的肿瘤学结局，并与未进行PSMA-PET/CT的患者进行比较。
将在RARP和ePLND之前接受PSMA-PET/CT分期的患者（“PSMA队列”；2016 - 2021年）与未进行PSMA-PET/CT分期的患者（“历史队列”；2013 - 2016年）进行比较。使用术前变量进行倾向评分匹配以限制混杂因素。作为主要结局指标，分析了无生化复发（BCR）生存期（BFS），BCR定义为前列腺特异性抗原值≥0.2 ng/ml或术后开始额外治疗。
匹配后，共纳入880例患者（每个队列440例）。整个队列的中位随访时间为35个月（四分位间距21 - 60个月）。在PSMA队列中，126/440例患者（29%）发生BCR，而历史队列中为205/440例（47%）（对数秩检验p = 0.032）。多变量Cox回归分析显示术前PSMA-PET/CT分期对BFS有独立影响（风险比0.70，95%置信区间0.55 - 0.89，p = 0.0030）。
接受PSMA-PET/CT分期的患者在RARP和ePLND后无生化进展生存期比未接受PSMA-PET/CT分期的患者更长。这表明PSMA-PET/CT分期改变了RARP和ePLND的患者选择，并与仍接受手术的患者早期肿瘤学结局改善相关。
前列腺癌诊断时的前列腺特异性膜抗原（PSMA）正电子发射断层扫描/计算机断层扫描（PET/CT）能更好地显示转移灶，从而更好地选择前列腺癌手术患者。诊断时接受PSMA-PET/CT扫描的患者肿瘤学结局改善，包括更长的无进展生存期和术后更低的前列腺特异性抗原残留率。
