前列腺特異性膜抗原正子掃描於進展性前列腺癌的治療策略與文獻回顧

謝博彥^1,2、陳思如¹、洪晟鈞¹、李建儀¹、裘坤元¹

¹台中榮民總醫院 泌尿部；²臺北醫學大學 醫學系

Treatment Strategy and Systemic Review with PSMA PET/CT Scan in Progressive Advanced Prostate Cancer

PO-YEN HSIEH¹², SZU-JU CHEN¹, SHENG-CHUN HUNG³, JIAN-RI LEE³,
KUN-YUAN CHIU³

¹ Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan;

 ²School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;

Purpose: Prostate cancer (CaP) is the most common cancer in men worldwide and is also the seventh leading cause of cancer-related deaths among men in Taiwan. Prostate-specific membrane antigen (PSMA), a surface glycoprotein, is highly expressed on most prostate cancer cells especially in poorly differentiated or metastatic castration resistant CaP. Therefore, it had become an attractive diagnostic and therapeutic target for small molecule ligands. Positron emission tomography (PET) of 68Ga-labelled prostate-specific membrane antigen (68Ga-PSMA) has already received U.S. Food and Drug Administration approval to assess the local and metastatic burden of prostate cancer. Some studies found 68Ga-PSMA PET provides higher sensitivity and specificity than traditional imaging. This study aimed to analysis the role of PSMA PET scan for recurrent CaP after radical prostatectomy.

Materials and Methods: We had reviewed our hospital database and enrolled 12 patients who were found biochemical recurrence after primary treatment with Robotic assisted radical prostatectomy (RaRP). The age of them ranged from 58-79-year-old. All of them was diagnosed with prostate adenocarcinoma with pathological staging above pT2. They had received PSMA PET scan and accepted adjuvant treatment with RT or metastasectomy (MTX).

Results: The interval between RaRP and BCR ranged from 12 to 105 months. The detection rate of PSMA PET scan was more than 90%. The most common sites of enhancement including prostate bed, bone, iliac or obturator lymph node, and previously surgical anastomosis. Among them, adjuvant radiotherapy was arranged in ten patients and lymph node dissection was underwent in two patients. Despite BCR happened again in most patients, it provided early detection and clearer metatstatic sites.

All of them was under hormone therapy or active surveillance with stable PSA level now.

Conclusion: PSMA PET scan seems to be effective to identify recurrent localization after BCR earlier in our study which had the similar result in previous analyses. Further prospective studies need to determine whether these changes in management ultimately result in improved patient outcome.