Impact of 68Ga-PSMA-11 PET staging on clinical decision-making in patients with intermediate or high-risk prostate cancer
Impact of 68Ga-PSMA-11 PET staging on clinical decision-making in patients with intermediate or high-risk prostate cancer
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DOI：
10.1007/s00259-019-04568-1
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发表时间：
2019-12-04
影响因子：
9.1
通讯作者：
Burger, Irene A.
中科院分区：
文献类型：
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作者：
Ferraro, Daniela A.;Schueler, Helena I. Garcia;Burger, Irene A.
背景准确的分期对于确定前列腺癌患者的最佳治疗方式至关重要。正电子发射断层扫描（PET）与前列腺特异性膜抗原（PSMA）是一种很有前途的技术，在检测淋巴结和远处转移方面优于传统成像。然而，目前尚不清楚是否优越的敏感性和特异性也转化为改善患者管理。本研究的目的是评估Ga-68-PSMA-11 PET在中高危前列腺癌分期中的表现及其对疾病管理的潜在影响。方法回顾性分析2016年4月至2018年5月期间116例接受Ga-68-PSMA-11 PET/CT或MRI扫描的中高危前列腺癌分期患者。在模拟的多学科肿瘤委员会中评估Ga-68-PSMA-11 PET分期对患者管理的潜在影响，根据临床信息和常规影像学确定假设的治疗决策。将该治疗决定与基于临床信息和Ga-68-PSMA-11 PET成像的治疗建议进行比较。结果113例（97%）原发肿瘤Ga-68-PSMA-11 PET阳性。结节转移28例（24%），骨转移14例（12%）。与临床分期和常规影像学相比，Ga-68-PSMA-11 PET在116例患者中有42例（36%）获得了新的信息。116例患者中有32例（27%），这些信息很可能会改变治疗方法，采取不同的治疗方式（15例，13%）或调整治疗细节（如修改放疗场或淋巴结清扫模板；17例，14%）。结论来自Ga-68-PSMA-11 PET分期的信息有可能改变超过四分之一接受PET分期的中高危前列腺癌患者的治疗。这些更加个性化的基于Ga-68-PSMA-11 pet的治疗决策是否会改善患者的预后还需要进一步的研究。
Background Accurate staging is of major importance to determine the optimal treatment modality for patients with prostate cancer. Positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) is a promising technique that outperformed conventional imaging in the detection of nodal and distant metastases in previous studies. However, it is still unclear whether the superior sensitivity and specificity also translate into improved patient management. The aim of this study was to assess the performance of Ga-68-PSMA-11 PET for staging of intermediate and high-risk prostate cancer and its potential impact on disease management. Methods In this retrospective analysis, 116 patients who underwent Ga-68-PSMA-11 PET/CT or MRI scans for staging of their intermediate or high-risk prostate cancer between April 2016 and May 2018 were included. The potential impact of Ga-68-PSMA-11 PET staging on patient management was assessed within a simulated multidisciplinary tumour board where hypothetical treatment decisions based on clinical information and conventional imaging alone was determined. This treatment decision was compared with the treatment recommendation based on clinical information and Ga-68-PSMA-11 PET imaging. Results The primary tumour was positive on Ga-68-PSMA-11 PET in 113 patients (97%). Nodal metastases were detected in 28 patients (24%) and bone metastases in 14 patients (12%). Compared with clinical staging and conventional imaging, Ga-68-PSMA-11 PET resulted in new information in 42 of 116 patients (36%). In 32 of 116 patients (27%), this information would most likely have changed the management into a different therapy modality (15 patients, 13%) or adjusted treatment details (e.g. modification of radiotherapy field or lymph node dissection template; 17 patients, 14%). Conclusion Information from Ga-68-PSMA-11 PET staging has the potential to change the management in more than a fourth of the patients who underwent PET staging for their intermediate to high-risk prostate cancer. Whether these more personalized Ga-68-PSMA-11 PET-based treatment decisions will improve patient outcome needs further investigation.