YÜKSEK RİSKLİ PROSTAT KANSERİNDE 68GA-PSMA PET/BT’NİN TEDAVİ YÖNETİMİNE ETKİSİ

Abstract

Amaç: Yüksek riskli prostat kanserinde (PK) 68Ga-PSMA PET/ BT’nin (PSMA PET) tedavi yönetimine etkisi değerlendirildi. Gereç ve Yöntem: Yüksek riskli PK nedeniyle evreleme amaçlı PSMA PET yapılan hastalar retrospektif olarak değerlendirildi. Hastaların PSMA PET öncesi abdominopelvik BT (n=126), pelvik MR (n=42) ve kemik sintigrafisi (KS) (n=40) bulunmaktaydı. Tüm klinik, biyokimya ve görüntüleme datası belgelendi. Hastalara uygulanan tedavilerin incelenmesi amacıyla hastalar takibe alındı. PK ile ilişkili artmış PSMA tutulumları önceden PSMA-RADS versiyon 1,0’da tanımlanan 5 puanlı skalaya göre belgelendi. PSMA PET’in hasta yönetimine etkisi pre-post PET/BT anketler ile retrospektif olarak değerlendirildi. PSMA PET sonuçlarına göre yönetim değişikliği inter ve intramodalite değişiklik olarak kategorize edildi. Altgruplar eşleştirilmiş t-testi ile SPSS version 24,0 programında karşılaştırıldı. p değeri <0,05 anlamlı kabul edildi. Bulgular: Toplam 126 hasta çalışmaya dahil edildi. Medyan PSA değeri 30,8 ng/ml (%95CI: 2,1-268,6 ng/ml) ve medyan GS 8 (range: 6-10) idi. PSMA PET sonuçlarına göre 41 hastada (%32,5) hastalık daha çok yaygın iken, 2 hastada (%1,6) daha az yaygın idi. Toplamda tedavi yönetimi 38 hastada (%30,1) değişti. Intermodalite değişiklik 29 hastada (%23) görülürken, intramodalite değişiklik 9 hastada (%7,1) görüldü. Yönetimdeki değişiklik KS olan ve olmayan grupta, %30 ve %30,2 ile benzerdi. Sonuç: PSMA PET yüksek riskli PK’de hastalar standart görüntülemeler ile evrelense bile neredeyse üçte birinde tedavi yönetimini etkilemektedir.

Keywords

• 68Ga-PSMA PET/BT
• prostat kanseri
• evreleme
• tedavi yönetimi

THE IMPACT OF 68GA-PSMA PET/CT ON THERAPY MANAGEMENT OF HIGH RISK PROSTATE CANCER

Abstract

Objective: We evaluated the impact of 68Ga-PSMA PET/CT (PSMA PET) on therapy management of newly diagnosed highrisk prostate cancer (PCa). Material and Method: Patients who underwent a PSMA PET for primary staging of high-risk PCa were evaluated retrospectively. Patients had abdominopelvic CT (n=126), pelvic MRI (n=42) and bone scintigraphy (BS) (n=40) prior to PSMA PET. All clinical, biochemical, and imaging data were documented. Increased PSMA uptakes related to PCa were documented according to previously described PSMA-RADS version 1.0 based on a fivepoint scale. The impact of PSMA PET on patient management was evaluated through pre and post PET/CT questionnaires, retrospectively. Management changes were categorized as inter or intramodality change, based on PSMA PET results. Paired samples t-test was used to compare subgroups in SPSS version 24.0 software. A p-value <0.05 was considered significant. Results: A total of 126 patients were included in the study. The median PSA level was 30.8 ng/ml (95%CI: 2.1-268.6 ng/ml) and median GS was 8 (range: 6-10). Based on the PSMA PET findings, 41 patients (32.5%) had more extensive disease and 2 patients (1.6%) had less extensive disease. Overall, therapy management was changed in 38 patients (30.1%). Intermodality changes occurred in 29 patients (23%), and intramodality changes occurred in 9 patients (7.1%). The change in management was similar in patients with BS and without BS, 30% vs. 30.2%. Conclusion: PSMA PET impacted the therapy management in almost one-third of patients in high-risk PCa even though they had already been staged with standard imaging modalities.

Keywords

• 68Ga-PSMA PET/CT
• prostate cancer
• staging
• therapy management

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