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Abstract：
Introduction: Prostate Specific Membrane Antigen Positron Emission Tomography (PSMA-PET) is routinely used for the staging of patients with prostate cancer, but data on response assessment are sparse and primarily stem from metastatic castration-resistant prostate cancer (mCRPC) patients treated with PSMA radioligand therapy. Still, follow-up PSMA-PET is employed in earlier disease stages in case of clinical suspicion of disease persistence, recurrence or progression to decide if localized or systemic treatment is indicated. Therefore, the prognostic value of PSMA-PET derived tumor volumes in earlier disease stages (i.e., hormone-sensitive prostate cancer (HSPC) and non-[177Lu]Lu-PSMA-617 (LuPSMA) therapy castration resistant prostate cancer (CRPC)) are evaluated in this manuscript. Methods: A total number of 73 patients (6 primary staging, 42 HSPC, 25 CRPC) underwent two (i.e., baseline and follow-up, median interval: 379 days) whole-body [68Ga]Ga-PSMA-11 PET/CT scans between Nov 2014 and Dec 2018. Analysis was restricted to non-LuPSMA therapy patients. PSMA-PETs were retrospectively analyzed and primary tumor, lymph node-, visceral-, and bone metastases were segmented. Body weight-adjusted organ-specific and total tumor volumes (PSMAvol: sum of PET volumes of all lesions) were measured for baseline and follow-up. PSMAvol response was calculated as the absolute difference of whole-body tumor volumes. High metastatic burden (>5 metastases), RECIP 1.0 and PSMA-PET Progression Criteria (PPP) were determined. Survival data were sourced from the cancer registry. Results: The average number of tumor lesions per patient on the initial PET examination was 10.3 (SD 28.4). At baseline, PSMAvol was strongly associated with OS (HR 3.92, p <0.001; n = 73). Likewise, response in PSMAvol was significantly associated with OS (HR 10.48, p < 0.005; n = 73). PPP achieved significance as well (HR 2.19, p <0.05, n = 73). Patients with hormone sensitive disease and poor PSMAvol response (upper quartile of PSMAvol change) in follow-up had shorter outcome (p < 0.05; n = 42). PSMAvol in bones was the most relevant parameter for OS prognostication at baseline and for response assessment (HR 31.11 p < 0.001; HR 32.27, p < 0.001; n = 73). Conclusion: PPP and response in PSMAvol were significantly associated with OS in the present heterogeneous cohort. Bone tumor volume was the relevant miTNM region for OS prognostication. Future prospective evaluation of the performance of organ specific PSMAvol in more homogeneous cohorts seems warranted.
摘要：
简介：前列腺特异性膜抗原正电子发射断层扫描（PSMA-PET）通常用于前列腺癌患者的分期，但疗效评估的数据很少,主要来自接受PSMA放射性配体治疗的转移性去势抵抗性前列腺癌(mCRPC)患者.尽管如此，在临床怀疑疾病持续的情况下，PSMA-PET用于早期疾病阶段，复发或进展，以确定是否需要局部或全身治疗。因此,PSMA-PET衍生的肿瘤体积在早期疾病阶段的预后价值(即，在本手稿中评估了激素敏感性前列腺癌（HSPC）和非[177Lu]Lu-PSMA-617（LuPSMA）治疗的去势抵抗前列腺癌（CRPC）。方法：共73例患者(6例原发性分期，42HSPC,25CRPC)经历了两次(即，基线和随访，中位间隔：379天）2014年11月至2018年12月之间的全身[68Ga]Ga-PSMA-11PET/CT扫描。分析仅限于非LuPSMA治疗患者。对PSMA-PETs进行回顾性分析,原发肿瘤,淋巴结-，内脏-,骨转移被分割。测量经体重调整的器官特异性和总肿瘤体积(PSMAvol:所有病变的PET体积的总和)用于基线和随访。PSMAvol反应计算为全身肿瘤体积的绝对差异。高转移负荷（>5转移），确定RECIP1.0和PSMA-PET进展标准(PPP)。生存数据来源于癌症登记处。结果：初次PET检查时，每位患者的平均肿瘤病变数为10.3（SD28.4）。在基线,PSMAvol与OS密切相关(HR3.92,p<0.001;n=73)。同样，PSMAvol的反应与OS显著相关(HR10.48,p<0.005;n=73).PPP也达到了显著性(HR2.19,p<0.05,n=73)。激素敏感疾病和PSMAvol反应差（PSMAvol变化的上四分位数）的患者随访结果较短（p<0.05；n=42）。骨骼中的PSMAvol是基线时OS预测和反应评估中最相关的参数（HR31.11p<0.001；HR32.27，p<0.001；n=73）。结论：在本异质队列中，PSMAvol中的PPP和反应与OS显着相关。骨肿瘤体积是OS预后的相关miTNM区域。未来对器官特异性PSMAvol在更同质队列中的性能进行前瞻性评估似乎是有道理的。
