Prevalence And Prognosis Of Low-Volume, Oligorecurrent, Hormone-Sensitive Prostate Cancer Amenable To Lesion Ablative Therapy
BJU INTERNATIONAL(2017)
摘要
ObjectivesTo describe the anatomical patterns of prostate cancer (PCa) recurrence after primary therapy and to investigate if patients with low-volume disease have a better prognosis as compared with their counterparts.Materials and MethodsPatients eligible for an 18-F choline positron-emission tomography (PET)-computed tomography (CT) were enrolled in a prospective cohort study. Eligible patients had asymptomatic biochemical recurrence after primary PCa treatment and testosterone levels >50ng/mL. The number of lesions was counted per scan. Patients with isolated local recurrence (LR) or with 3 metastases (with or without LR) were considered to have low-volume disease and patients with >3 metastases to have high-volume disease. Descriptive statistics were used to report recurrences. Cox regression analysis was used to investigate the influence of prognostic variables on the time to developing castration-resistant PCa (CRPC).ResultsIn 208 patients, 625 sites of recurrence were detected inthe lymph nodes (N1/M1a: 30%), the bone (18%), theprostate (bed; 11%), viscera (4%), or a combination of any of the previous (37%). In total, 153 patients (74%) hadlow-volume recurrence and 55 patients (26%) hadhigh-volume recurrence. The 3-year CRPC-free survivalrate for the whole cohort was 79% (95% confidence interval 43-55), 88% for low-volume recurrences and 50% for high-volume recurrences (P<0.001). Longer PSA doubling time at time of recurrence and low-volumedisease were associated with a longer time to CRPC.ConclusionsThree out of four patients with PCa with a 18-F choline PET-CT-detected recurrence have low-volume disease, potentially amenable to local therapy. Patients with low-volume disease have a better prognosis as compared with their counterparts. Lymph node recurrence was the most dominant failure pattern.
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关键词
prostatic neoplasms, neoplasm metastasis, oligometastasis, neoplasm recurrence, choline PET-CT
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