PSMA PET/CT Patterns of Recurrence After Mono-Brachytherapy in Men with Low and Intermediate Prostate Cancer and Subsequent Management
Notice bibliographique
Résumé
Abstract Purpose Brachytherapy as monotherapy is a recommended treatment option for men with low to intermediate risk prostate cancer, achieving biochemical progression-free survival rates >95% at 5 years. Local recurrence is difficult to identify due to sensitivity of conventional imaging and post-brachytherapy artefacts. Biochemical recurrence (BCR) in this setting is often considered as systemic recurrence, treated with androgen-deprivation therapy (ADT) as primary salvage therapy. This study investigated PSMA PET/CT for recurrence after low-dose rate (LDR) and high-dose rate (HDR) brachytherapy as monotherapy in men with low or intermediate prostate cancer, as well as subsequent management when recurrence occurred only within the prostate. Methods We performed a retrospective single-centre analysis for patients who were treated with brachytherapy as monotherapy for prostate cancer from May 2002 to May 2021 to identify men who underwent [68Ga]Ga-PSMA-11 or [18F]DCFPyL PET/CT (PSMA PET/CT) for BCR. We report the findings on PSMA PET/CT, quantitative parameters, as well as the subsequent management of the patients. Results Forty patients were identified who underwent PSMA PET/CT (26 LDR and 14 HDR) to investigate a rising PSA at a median (IQR) of 7 years (3.0-10.8) after initial therapy. Median (IQR) PSA at time of PSMA PET/CT was 6.6 ng/mL (3.9 - 15.5). On PSMA PET/CT, 20/40 (50%) men had prostate-only recurrence, 5/40 (12.5%) had nodal recurrence, 2/40 (5%) had bone-only metastases, 10/40 (25%) had multiple sites of recurrence and 3/40 (7.5%) had no visible sites of recurrence. Of the 20 patients with prostate-only recurrence, 8/20 (40%) had recurrence in a high-dose radiation zone, such as within the brachytherapy seeds, versus 7/20 (35%) in an under-covered zone, such as seminal vesicles or prostate base. On PSMA PET/CT, recurrence within the prostate had median (IQR) SUVmax 10.4 (5.1-15.7) and volume 2.9 mL (2.0-11.2). Subsequent management of these patients with local recurrence included surveillance followed by ADT (9/20, 45%), salvage SBRT (3/20, 15%), salvage brachytherapy (2/20, 10%), salvage radical prostatectomy (1/20, 5%) and not treated/lost to follow-up (5/20, 25%). For those with surveillance followed by ADT, the mean time before introduction of ADT was 4.1 years (range 1 to 8 years). Conclusion In the setting of BCR following mono-brachytherapy, PSMA PET/CT effectively identified local recurrence occurring within the prostate, including within high-dose radiation zones. It may be safe to delay the introduction of ADT, though more research is required.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».