目的对比分析以68镓（68Ga）标记的靶向前列腺特异性膜抗原（PSMA）分子探针PSMA-11为示踪剂的PET-CT（68Ga-PSMA-11 PET-CT）与全身磁共振成像（WB-MRI）诊断前列腺癌远处转移的效能。 方法回顾性分析2019年1月至12月我院收治的行68Ga-PSMA-11 PET-CT及WB-MRI的52例前列腺癌患者的临床资料。由核医学科及影像医学科主治医师各2名分别对患者的68Ga-PSMA-11 PET-CT和WB-MRI检查结果进行盲法分析，并以最佳比较标准（BVC）为金标准对患者进行分组。根据结果绘制ROC曲线并计算AUC，对2种检查方法的灵敏度、特异度等进行统计分析。 结果入组的52例前列腺癌患者中20例无远处转移、32例发生远处转移。WB-MRI检测远处转移的AUC为0.844（95% CI 0.719~0.968），灵敏度为93.75%（30/32）、特异度为75.00%（15/20）；68Ga-PSMA-11 PET-CT检测远处转移的AUC为0.959（95% CI 0.893~1.000），灵敏度为96.88%（31/32）、特异度为95.00%（19/20），2种方法的灵敏度及特异度差异均无统计学意义（P均>0.05）。远处转移患者中有25例发生骨转移、29例发生淋巴结转移。68Ga-PSMA-11 PET-CT检测前列腺癌骨转移灶的灵敏度为92.00%（23/25）、特异度为100.00%（27/27），WB-MRI检测灵敏度为60.00%（15/25）、特异度为88.89%（24/27），2种方法灵敏度差异有统计学意义（P=0.04）；2种方法对淋巴结转移检测的灵敏度[89.66%（26/29）vs 86.21%（25/29）]及特异度[95.65%（22/23）vs 91.30%（21/23）]差异均无统计学意义（P均>0.05）。 结论68Ga-PSMA-11 PET-CT与WB-MRI检测前列腺癌远处转移均具有较高的诊断效能。在骨转移的诊断方面，68Ga-PSMA-11 PET-CT的诊断效能优于WB-MRI。

68 Ga-PSMA-11 PET-CT与全身磁共振成像诊断前列腺癌远处转移的效能比较

In the past decade, a revolution in the treatment of metastatic prostate cancer has occurred with the advent of novel hormonal agents and life-prolonging chemotherapy regimens in combination with standard androgen-deprivation therapy. Notwithstanding, the use of systemic therapy alone can result in a castrate-resistant state; therefore, increasing focus is being placed on the additional survival benefits that could potentially be achieved with local cytoreductive and/or metastasis-directed therapies. Local treatment of the primary tumour with the established modalities of radiotherapy and radical prostatectomy has been explored in this context, and the use of novel minimally invasive ablative therapies has been proposed. In addition, evidence of the potential clinical benefits of metastasis-directed therapy with ionizing radiation (primarily stereotactic ablative radiotherapy) is accumulating. Herein, we summarize the pathobiological rationale for local cytoreduction and the potentially systemic immunological responses to radiotherapy and ablative therapies in patients with metastatic prostate cancer. We also discuss the current evidence base for a cytoreductive strategy, including metastasis-directed therapy, in the current era of sequential multimodal therapy incorporating novel treatments. Finally, we outline further research questions relating to this complex and evolving treatment landscape. Systemic hormone therapies and chemotherapy are the cornerstones of treatment for patients with de novo metastatic prostate cancer, with a currently limited role for local treatments. Herein, the authors outline the pathobiological and immunological rationale for local cytoreductive treatment of the primary tumour and/or metastases in patients with this disease. They also review the preclinical and clinical evidence for the use of radical prostatectomy, prostate radiotherapy, minimally invasive ablative therapies, and metastasis-directed therapy (predominantly with stereotactic ablative radiotherapy) in this population.

Cytoreductive treatment strategies for de novo metastatic prostate cancer

Oligometastatic Prostate Cancer: Results of a Dutch Multidisciplinary Consensus Meeting

(68)ga-prostate specific membrane antigen (psma) positron emission tomography (pet) for primary staging of high risk prostate cancer: a systematic review

Over the past decade, updated definitions for the different stages of prostate cancer and risk for distant disease, along with the advent of new therapies, have remarkably changed the management of patients. The two expectations from imaging are accurate staging and appropriate assessment of disease response to therapies. Modern, next-generation imaging (NGI) modalities, including whole-body magnetic resonance imaging (WB-MRI) and nuclear medicine (most often prostate-specific membrane antigen [PSMA] positron emission tomography [PET]/computed tomography [CT]) bring added value to these imaging tasks. WB-MRI has proven its superiority over bone scintigraphy (BS) and CT for the detection of distant metastasis, also providing reliable evaluations of disease response to treatment. Comparison of the effectiveness of WB-MRI and molecular nuclear imaging techniques with regard to indications and the definition of their respective/complementary roles in clinical practice is ongoing. This paper illustrates the evolution of WB-MRI imaging protocols, defines the current state-of-the art, and highlights the latest developments and future challenges. The paper presents and discusses WB-MRI indications in the care pathway of men with prostate cancer in specific key situations: response assessment of metastatic disease, "all in one" cancer staging, and oligometastatic disease.

Whole-body magnetic resonance imaging for prostate cancer assessment: Current status and future directions.

Amongst the unanswered questions regarding prostate cancer (PCa), the optimal management of oligometastatic disease remains one of the major concerns of the scientific community. The very existence of this category is still subject to controversy. Aim of this systematic review is to summarize current available data on the most appropriate management of oligometastatic PCa. All relevant studies published in English up to November the 1st were identified through systematic searches in PubMed, EMBASE, Cochrane Library, CINAHL, Google Scholar and Ovid database. A search was performed including the combination of following words: (prostate cancer) and (metastatic) and [(oligo) or (PSMA) or (cytoreductive) or (stereotaxic radiotherapy) or (prostatectomy)]. 3335 articles were reviewed. After title screening and abstract reading, 118 papers were considered for full reading, leaving a total of 36 articles for the systematic review. There is still no consensus on the definition of oligometastatic disease, nor on the imaging modalities used for its detection. While retrospective studies suggest an added benefit with the treatment the primitive tumor by cytoreductive prostatectomy (55% survival rate vs 21%, p < 0.001), prospective studies do not validate the same outcome. Nonetheless, most studies have reported a reduction in local complications after cytoreductive prostatectomy (< 10%) compared to the best systemic treatment (25–30%). Concerning radiotherapy, an overall survival benefit for patients with a low metastatic burden was found in STAMPEDE (HR 0.68, 95% CI 0.52–0.90; p = 0.007) and suggested in subgroup analysis of the HORRAD trial. Regarding the impact of metastases-directed therapy (MDT), the STOMP and ORIOLE trials suggested that metastatic disease control might improve androgen deprivation therapy-free survival (in STOMP: 21 vs 13 months for MDT vs standard of care). Nonetheless, the impact of MDT on long-term oncologic results remains unclear. Finally, oligometastatic disease appears to be a biologically different entity compared to high-burden metastatic disease. New findings on exosomes appear to make them intriguing biomarkers in the early phases of oligometastatic PCa. Oligometastatic PCa is today a poorly understood disease. The implementation of new imaging techniques as whole-body MRI and PSMA PET/CT has increased exponentially the number of oligometastatic patients detected. Data of available trials suggest a benefit from cytoreductive prostatectomy to reduce local complication, though its impact on survival remains unknown. Radiotherapy may be beneficial for patients with low-burden metastatic PCa, while MDT may delay the need for androgen deprivation therapy. Results from ongoing trials data are eagerly awaited to draw reliable recommendations.

A systematic review of contemporary management of oligometastatic prostate cancer: fighting a challenge or tilting at windmills?

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A systematic review of contemporary management of oligometastatic prostate cancer: fighting a challenge or tilting at windmills?