Lanfranchi Francesco, Belgioia Liliana, Albano Domenico, Triggiani Luca, Linguanti Flavia, Urso Luca, Mazzola Rosario, Rizzo Alessio, D'Angelo Elisa, Dondi Francesco, Mataj Eneida, Pedersoli Gloria, Abenavoli Elisabetta Maria, Vaggelli Luca, Detti Beatrice, Ortolan Naima, Malorgio Antonio, Guarneri Alessia, Garrou Federico, Fiorini Matilde, Grimaldi Serena, Ghedini Pietro, Iorio Giuseppe Carlo, Iudicello Antonella, Rovera Guido, Fornarini Giuseppe, Bongiovanni Diego, Marcenaro Michela, Pazienza Filippo Maria, Timon Giorgia, Salgarello Matteo, Racca Manuela, Bartolomei Mirco, Panareo Stefano, Ricardi Umberto, Bertagna Francesco, Alongi Filippo, Barra Salvina, Morbelli Silvia, Sambuceti Gianmario, Bauckneht Matteo
Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
Department of Radiotherapy, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Radiol Imaging Cancer. 2025 May;7(3):e240150. doi: 10.1148/rycan.240150.
Prospective trials suggest that metastasis-directed therapy (MDT) is an effective treatment for patients with oligometastatic prostate cancer (PCa). Gallium 68 (Ga) prostate-specific membrane antigen (PSMA)-11 PET/CT-guided MDT seems to improve the oncologic outcome in these patients compared with fluorine 18 (F)-fluorocholine and F-PSMA-1007 PET/CT-guided MDT, but the effects in terms of local or distant disease control remain unclear. Thus, the present subanalysis of the PRECISE-MDT study analyzed patients with hormone-sensitive PCa who underwent MDT guided by PET/CT for nodal or bone oligorecurrent disease and were restaged with the same imaging modality in case of biochemical recurrence after MDT. Among 340 lesions detected in 241 male patients (median age, 74 [IQR, 9] years), F-fluorocholine, Ga-PSMA-11, and F-PSMA-1007 PET/CT-guided MDT was performed in 179, 81, and 80 lesions, respectively. At restaging imaging, the PET/CT imaging modality used to guide MDT was not significantly associated with local recurrence-free survival (LRFS), with median LRFS not reached for Ga-PSMA-11 PET/CT, F-PSMA-11 PET/CT, and F-fluorocholine PET/CT ( = .73). However, the detection rate of a new metastasis was significantly higher if MDT was guided by F-fluorocholine PET/CT (119 of 179 lesions, 66.5%) compared with Ga-PSMA-11 or F-PSMA-1007 PET/CT (23 of 81 lesions, 28%, and 27 of 80, 34%, respectively; < .001 for both). Moreover, MDT guided by Ga-PSMA-11 PET/CT led to an improved median metastasis-free survival (MFS) (not reached) compared with F-PSMA-1007 (median MFS, 24.9 months; < .001) or F-fluorocholine PET/CT (median MFS, 18 months; < .001). These findings suggest that using different PET/CT imaging modalities to guide MDT might impact the distant disease control in this clinical scenario. Radiation Therapy, Oncology, Urinary, Prostate, PET/CT Published under a CC BY 4.0 license.
前瞻性试验表明，转移导向治疗（MDT）是寡转移前列腺癌（PCa）患者的有效治疗方法。与氟-18（F）-氟胆碱和F-PSMA-1007 PET/CT引导的MDT相比，镓68（Ga）前列腺特异性膜抗原（PSMA）-11 PET/CT引导的MDT似乎能改善这些患者的肿瘤学结局，但在局部或远处疾病控制方面的效果仍不明确。因此，本项对PRECISE-MDT研究的亚组分析，纳入了激素敏感性PCa患者，这些患者因淋巴结或骨寡复发性疾病接受PET/CT引导的MDT，并在MDT后生化复发时采用相同的成像方式进行重新分期。在241例男性患者（中位年龄74[四分位间距，9]岁）检测到的340个病灶中，分别有179个、81个和80个病灶接受了F-氟胆碱、Ga-PSMA-11和F-PSMA-1007 PET/CT引导的MDT。在重新分期成像时，用于引导MDT的PET/CT成像方式与无局部复发生存期（LRFS）无显著相关性，Ga-PSMA-11 PET/CT、F-PSMA-11 PET/CT和F-氟胆碱PET/CT的中位LRFS均未达到（P = 0.73）。然而，与Ga-PSMA-11或F-PSMA-1007 PET/CT相比，F-氟胆碱PET/CT引导的MDT发现新转移灶的发生率显著更高（179个病灶中的119个，66.5%），而Ga-PSMA-11或F-PSMA-1007 PET/CT分别为81个病灶中的23个（28%）和80个病灶中的27个（34%）；两者比较均P < 0.001）。此外，与F-PSMA-1007（中位无转移生存期，24.9个月；P < 0.001）或F-氟胆碱PET/CT（中位无转移生存期，18个月；P < 0.001）相比，Ga-PSMA-11 PET/CT引导的MDT使中位无转移生存期（MFS）得到改善（未达到）。这些发现表明，在这种临床情况下，使用不同的PET/CT成像方式来引导MDT可能会影响远处疾病控制。放射治疗、肿瘤学、泌尿学、前列腺、PET/CT 依据知识共享署名4.0许可协议发布。
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