前列腺特异性膜抗原（PSMA）阴性的正电子发射断层扫描（PET）可用于避免对中危前列腺癌患者进行不必要的盆腔淋巴结清扫术。
Negative PSMA PET can be used to avoid unnecessary pelvic lymph node dissection in intermediate risk prostate cancer.
作者信息
Incesu Reha-Baris, Preisser Felix, Nohe Florian, Maurer Tobias, Graefen Markus, Tilki Derya
机构信息
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany.
Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Prostate Cancer Prostatic Dis. 2025 Jan 6. doi: 10.1038/s41391-024-00930-z.
BACKGROUND
Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) has a high negative predictive value (NPV) in determining lymph node invasion (LNI) in men with intermediate-risk disease undergoing radical prostatectomy (RP) and pelvic lymph node dissection (PLND). We hypothesized that PSMA PET may be used to reduce the number of unnecessary PLND procedures performed.
OBJECTIVE
To assess BCR-free survival of intermediate risk prostate cancer patients with a negative PSMA PET who underwent PLND vs. no PLND.
DESIGN, SETTING, AND PARTICIPANTS: Within a high-volume center database, we identified patients with Grade Group 2-3 and PSA ≤ 20 ng/ml who had a negative PSMA PET prior to RP between 2016 and 2021.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Kaplan-Meier analyses were used to compare BCR-free survival between patients with and without PLND.
RESULTS AND LIMITATIONS
Overall, 371 patients were identified. Of those, 333 (90%) underwent RP with PLND, while 38 (10%) had no PLND during RP. Median number of removed lymph nodes in patients with PLND was 16. The NPV of PSMA PET for LNI detection was 90.1%. Median follow-up was 36 months. The median preoperative PSA was 7.8 ng/ml. 59% had biopsy Grade Group 2 and 41% had biopsy Grade Group 3, respectively. BCR-free survival at 36 months after prostatectomy was 78.7% vs. 76.7% (p = 0.8) for patients with vs. without PLND. Main limitation is the absence of long-term oncologic outcomes.
CONCLUSIONS
In intermediate risk prostate cancer patients, a PLND may be avoided in the presence of a negative PSMA PET.
背景
前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）在确定接受根治性前列腺切除术（RP）和盆腔淋巴结清扫术（PLND）的中危疾病男性患者的淋巴结侵犯（LNI）方面具有较高的阴性预测值（NPV）。我们推测PSMA PET可用于减少不必要的PLND手术数量。
目的
评估接受PLND与未接受PLND的PSMA PET阴性的中危前列腺癌患者的无生化复发（BCR）生存率。
设计、设置和参与者：在一个大容量中心数据库中，我们识别出2016年至2021年间在RP前PSMA PET阴性、Grade Group 2-3且PSA≤20 ng/ml的患者。
结果测量和统计分析
采用Kaplan-Meier分析比较接受和未接受PLND的患者的无BCR生存率。
结果和局限性
总体而言，共识别出371例患者。其中，333例（90%）接受了RP及PLND，而38例（10%）在RP期间未进行PLND。接受PLND的患者切除淋巴结的中位数为16个。PSMA PET检测LNI的NPV为90.1%。中位随访时间为36个月。术前PSA中位数为7.8 ng/ml。分别有59%的患者活检为Grade Group 2，41%的患者活检为Grade Group 3。前列腺切除术后36个月时，接受PLND与未接受PLND的患者的无BCR生存率分别为78.7%和76.7%（p = 0.8）。主要局限性是缺乏长期肿瘤学结果。
结论
在中危前列腺癌患者中，若PSMA PET结果为阴性，可避免进行PLND。
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