使用正电子发射断层扫描 (PET) 进行前列腺特异性膜抗原 (PSMA) 成像在前列腺癌治疗中发挥着至关重要的作用。然而，缺乏关于 PSMA PET/CT（计算机断层扫描）如何影响放射治疗决策的全面数据，特别是在淋巴结阳性前列腺癌病例中。本研究旨在通过评估两个主要目标来解决这一差距：(1) 与 PSMA PET/CT 相比，使用 CT 传统方法绘制主动脉分叉处的区域和非区域淋巴结 (LN) 及其分布图，以及（ 2) 评估 PSMA PET/CT 结果对放疗决策的影响。对 95 例淋巴结阳性前列腺癌患者进行回顾性分析，这些患者在初次放疗和雄激素剥夺治疗 (ADT) 之前接受了 CT 和 PSMA PET/CT 成像。分析的重点是识别不同区域的淋巴结，包括髂总站、髂外站、髂内站、闭孔站、骶前站、直肠系膜站、腹股沟站和其他站。根据 PSMA PET/CT 结果审查治疗计划以进行修改，并进行统计分析以确定 PSMA PET/CT 扫描中唯一淋巴结阳性的预测因素。PSMA PET/CT 在 48% 的病例中发现了额外的阳性淋巴结，从而导致29% 的患者分期从 N0 转变为 N1。最常见的转移性淋巴结位于髂外淋巴结（76 个淋巴结；34%）、髂内淋巴结（43 个淋巴结；19%）和髂总淋巴结（35 个淋巴结；15%）。在仅通过 PSMA PET 检测到淋巴结的患者中，最常见的淋巴结位于髂外站 (27, 40%)、髂内站 (13, 19%)、闭孔站 (11, 15%)。在 28 名仅表现出 PSMA PET 检测到的淋巴结的患者亚组中，5 名患者 (18%) 改变了放射治疗范围，23 名患者 (83%) 增加了剂量。然而，分析中没有出现 PSMA PET/CT 扫描中唯一淋巴结阳性的明显预测因子。该研究强调了 PSMA PET/CT 与单独 CT 相比，在准确分期淋巴结阳性前列腺癌和指导个性化放疗策略方面的关键作用。提倡将 PSMA PET/CT 常规整合到诊断方案中，以优化治疗精度并改善患者治疗结果。© 2024。作者。

Prostate Specific Membrane Antigen (PSMA) imaging with Positron Emission Tomography (PET) plays a crucial role in prostate cancer management. However, there is a lack of comprehensive data on how PSMA PET/CT (Computed Tomography) influences radiotherapeutic decisions, particularly in node-positive prostate cancer cases. This study aims to address this gap by evaluating two primary objectives: (1) Mapping the regional and non-regional lymph nodes (LNs) up to the aortic bifurcation and their distribution using conventional methods with CT compared to PSMA PET/CT, and (2) assessing the impact of PSMA PET/CT findings on radiotherapeutic decisions.A retrospective analysis of 95 node-positive prostate cancer patients who underwent both CT and PSMA PET/CT imaging prior to primary radiotherapy and androgen deprivation therapy (ADT) was conducted. The analysis focused on identifying LNs in various regions including the common iliac, external iliac, internal iliac, obturator, presacral, mesorectal, inguinal, and other stations. Treatment plans were reviewed for modifications based on PSMA PET/CT findings, and statistical analysis was performed to identify predictors for exclusive nodal positivity on PSMA PET/CT scans.PSMA PET/CT identified additional positive nodes in 48% of cases, resulting in a staging shift from N0 to N1 in 29% of patients. The most frequent metastatic LNs were located in the external iliac (76 LNs; 34%), internal iliac (43 LNs; 19%), and common iliac (35 LNs; 15%) stations. In patients with nodes only detected on PSMA PET the most common nodes were in the external iliac (27, 40%), internal iliac (13, 19%), obturator (11, 15%) stations. Within the subgroup of 28 patients exclusively demonstrating PSMA PET-detected nodes, changes in radiotherapy treatment fields were implemented in 5 cases (18%), and a dose boost was applied for 23 patients (83%). However, no discernible predictors for exclusive nodal positivity on PSMA PET/CT scans emerged from the analysis.The study underscores the pivotal role of PSMA PET/CT compared to CT alone in accurately staging node-positive prostate cancer and guiding personalized radiotherapy strategies. The routine integration of PSMA PET/CT into diagnostic protocols is advocated to optimize treatment precision and improve patient outcomes.© 2024. The Author(s).