根治性放疗 (RT) 后前列腺癌 (PCa) 的生化复发 (BCR) 是根据 Phoenix 标准定义的，即前列腺特异性抗原 (PSA) 升高高于 PSA 最低点 ≥2.0 ng/ml。基于前列腺特异性膜抗原 (PSMA) 的正电子发射断层扫描/计算机断层扫描 (PET/CT) 可以在 PSA 值非常低的情况下识别前列腺癌复发。我们的目的是调查治疗性放疗后 PSA 上升高于最低点 ≥2.0 ng/ml 的患者（Phoenix 阳性，Ph ）和未达到该阈值的患者（Phoenix 阳性）的 PCa 复发的检出率和程度。阴性，Ph-）并比较治疗管理和临床结果，包括雄激素剥夺治疗（ADT）和去势抵抗性前列腺癌（CRPC）的时间以及总生存率。我们对阿姆斯特丹前列腺癌网络进行了回顾性分析(2015-2023) 568 名接受 PCa 治疗性放疗的患者组成的队列。收集有关 PSMA PET/CT 结果、治疗管理和临床随访的数据，包括（重新）开始 ADT、进展为 CRPC 和生存。使用逻辑回归和生存分析对各组结果进行比较。研究队列包括 222 名被分类为 Ph- 的患者 (39.1%) 和 346 名被分类为 Ph 的患者 (60.9%)。在 170 名 Ph- 患者 (76.6%) 和 322 名 (93.1%) Ph 患者中检测到 PSMA 亲和性病变。在这些组中，75.9% 的 Ph- 患者和 45.0% 的 Ph 患者有资格接受局部挽救治疗（比值比 [OR 3.84]；p < 0.001）。 Ph 组 (n = 37, 21.8%) 的远处转移频率低于 Ph 组 (n = 157, 48.8%; OR 0.29; p < 0.001)。生存分析显示，Ph 组中 ADT（重新）开始和进展为 CRPC 的时间较长，总体死亡率较低（对数秩 p < 0.001）。回顾性研究设计是主要限制。对于 PCa 复发的患者，PSMA PET/CT 可以在大多数不符合 BCR 的 Phoenix 标准的病例中检测到这种复发。早期成像可以检测到疾病较晚期阶段的复发，从而可以进行潜在的挽救治疗。此外，早期 PSMA PET/CT 与 ADT（重新）开始和进展为 CRPC 的时间较长以及总生存期较长有关。这些积极的临床意义保证了我们在前瞻性研究中的结果得到证实，以减少潜在的前置时间偏差。我们研究了一种特殊类型的扫描，称为 PSMA PET（前列腺特异性膜抗原正电子发射断层扫描），用于怀疑前列腺复发的患者的早期使用放射治疗后的癌症。早期扫描可以在癌症进展到更晚期之前检测到复发。版权所有 © 2024 作者。由 Elsevier B.V. 出版。保留所有权利。

Biochemical recurrence (BCR) of prostate cancer (PCa) after curative radiotherapy (RT) is defined according to the Phoenix criteria, which is a prostate-specific antigen (PSA) rise of ≥2.0 ng/ml above the PSA nadir. Prostate-specific membrane antigen (PSMA)-based positron emission tomography/computed tomography (PET/CT) can identify PCa recurrences at very low PSA values. Our aim was to investigate the detection rate and extent of PCa recurrences using PSMA PET/CT after curative RT among patients with a PSA rise of ≥2.0 ng/ml above the nadir (Phoenix positive, Ph+) and patients not reaching this threshold (Phoenix negative, Ph-) and to compare therapeutic management and clinical outcomes in terms of time to androgen deprivation therapy (ADT) and castration-resistance PCa (CRPC), as well as overall survival.We conducted a retrospective analysis of the Prostate Cancer Network Amsterdam (2015-2023) cohort of 568 patients who received curative-intent RT for PCa. Data on PSMA PET/CT outcomes, therapeutic management, and clinical follow-up were collected, including (re)initiation of ADT, progression to CRPC, and survival. Results were compared between groups using logistic regression and survival analyses.The study cohort comprised 222 patients (39.1%) classified as Ph- and 346 (60.9%) classified as Ph+. PSMA-avid lesions were detected in 170 Ph- patients (76.6%) and 322 (93.1%) Ph+ patients. In these groups, 75.9% of Ph- patients and 45.0% of Ph+ patients were eligible for local salvage therapy (odds ratio [OR 3.84]; p < 0.001). Distant metastases were less frequent in the Ph- group (n = 37, 21.8%) than in the Ph+ group (n = 157, 48.8%; OR 0.29; p < 0.001). Survival analyses revealed longer times to ADT (re)initiation and progression to CRPC, as well as lower overall mortality, in the Ph- group (log-rank p < 0.001). The retrospective study design is the main limitation.For patients with PCa recurrence, PSMA PET/CT can detect this recurrence in the majority of cases not meeting the Phoenix criteria for BCR. Early imaging detects recurrences at a less advanced disease stage, allowing potential salvage treatments. In addition, early PSMA PET/CT is associated with longer times to ADT (re)initiation and progression to CRPC, as well as longer overall survival. These positive clinical implications warrant confirmation of our results in prospective studies to reduce potential leadtime bias.We investigated early use of a special type of scan called PSMA PET (prostate-specific membrane antigen positron emission tomography) in patients with suspicion of recurrence of their prostate cancer after radiotherapy. Early scans can detect recurrence before the cancer progresses to a more advanced stage.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.