Karanjia Rustam, Sarkar Pallab, Basavaraju Vishnu, Tayo Oluwabunmi, Kommu Sashi, Bashir Humayun, Streeter Edward
East Kent Hospitals University NHS Trust: East Kent Hospitals University NHS Foundation Trust Canterbury, Kent UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND.
J Cancer Allied Spec. 2025 May 29;11(1):24-28. doi: 10.2478/jcas-2025-0006. eCollection 2025 Jan.
EAU guidelines advise patients with intermediate risk Gleason 4+3=7 prostate cancer undergo cross-sectional abdominopelvic imaging and bone scan for metastatic screening. We hypothesised detection rate of extra-prostatic disease in this cohort is low using conventional CT/bone scans and could potentially be avoided.
Patients with overall Gleason 4+3 histology were identified over 69 months at East Kent University Hospitals NHS Trust. Patients were excluded if PSA >20ng/mL and/or MRI prostate >T3b stage. Primary outcomes were: (a) detection rates of metastatic disease using conventional CT and bone scan and b) the proportion of fully-staged patients with positive lymph nodes at dissection or biochemical recurrence following robotic-assisted laparoscopic prostatectomy (RALP).
A total of 134 patients were identified. Median age was 72 (range 45-83), PSA 7.8ng/mL (range 1.8-19.3) and prostate volume 40cc (range 10-129). 130/134(97%) had MRI scans prior to staging. 124/134(93%) had bone scans and 83/134(62%) had CT scans, of which 77/134(57%) had both. 0/124(0%) bone scans identified metastatic disease and only 2/83(2%) CT scans identified nodal disease not detected by MRI. 0/134(0%) had management changes from staging. 57/134(43%) patients negatively-staged proceeded to RALP. 19/57(32%) had lymph node dissections. 6(11%) had missed metastatic disease at 19 months median follow-up.
Detection of metastatic disease by conventional CT and bone scan was poor in this cohort, despite their presence, and their recommendation by EAU seems unwarranted. Patients could safely avoid these scans and proceed directly to radical treatment, due to the theoretical benefit of treating despite oligometastatic disease.
欧洲泌尿外科学会（EAU）指南建议，患有中危 Gleason 4+3=7 前列腺癌的患者应进行腹部盆腔横断面成像和骨扫描以进行转移灶筛查。我们推测，在这一队列中，使用传统 CT/骨扫描检测前列腺外疾病的检出率较低，且有可能避免进行此类检查。
在东肯特大学医院国民保健服务信托基金（East Kent University Hospitals NHS Trust）的 69 个月期间，确定了 Gleason 评分 4+3 组织学类型的患者。如果 PSA>20ng/mL 和/或前列腺 MRI>T3b 期，则将患者排除。主要结局为：（a）使用传统 CT 和骨扫描检测转移疾病的检出率，以及（b）在机器人辅助腹腔镜前列腺切除术（RALP）后，淋巴结清扫或生化复发时淋巴结阳性的完全分期患者的比例。
共确定了 134 例患者。中位年龄为 72 岁（范围 45 - 83 岁），PSA 为 7.8ng/mL（范围 1.8 - 19.3），前列腺体积为 40cc（范围 10 - 129）。130/134（97%）的患者在分期前进行了 MRI 扫描。124/134（93%）的患者进行了骨扫描，83/134（62%）的患者进行了 CT 扫描，其中 77/134（57%）的患者两者都做了。124 例骨扫描中 0 例（0%）发现转移疾病，83 例 CT 扫描中仅 2 例（2%）发现了 MRI 未检测到的淋巴结疾病。134 例患者中 0 例（0%）因分期结果而改变治疗方案。57/134（43%）分期为阴性的患者进行了 RALP。19/57（32%）进行了淋巴结清扫。在中位随访 19 个月时，6 例（11%）有漏诊的转移疾病。
在这一队列中，传统 CT 和骨扫描对转移疾病的检测效果不佳，尽管它们被使用，且 EAU 的推荐似乎没有依据。由于即使存在寡转移疾病进行治疗也有理论上的益处，患者可以安全地避免这些扫描并直接进行根治性治疗。
