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山东大学学报 (医学版) ›› 2019, Vol. 57 ›› Issue (1): 36-40.doi: 10.6040/j.issn.1671-7554.0.2018.1316

• • 上一篇    

PSMA SPECT/CT检查引导下的挽救性淋巴结清扫术在生化复发前列腺癌患者治疗中的价值

宿恒川1,朱耀1,戴波1,刘畅2,胡四龙2,叶定伟1   

  1. 1.复旦大学附属肿瘤医院泌尿外科, 复旦大学上海医学院肿瘤学系, 上海 200032;2.复旦大学附属肿瘤医院核医学科, 上海 200032
  • 发布日期:2022-09-27
  • 通讯作者: 叶定伟. E-mail:dwyeli@163.com
  • 基金资助:
    国家自然科学基金(81602222);第五批上海市青年医师培养计划(2017年)

Significance of 99mTc-PSMA SPECT/CT guided salvage lymph node dissection for prostate cancer patients with biochemical recurrence

SU Hengchuan1, ZHU Yao1, DAI Bo1, LIU Chang2, HU Silong2, YE Dingwei1   

  1. 1. Department of Urology, Shanghai Cancer Center of Fudan University, Shanghai Medical College, Fudan University, Shanghai 200032, China;
    2. Department of Nuclear Medicine, Shanghai Cancer Center of Fudan University, Shanghai 200032, China
  • Published:2022-09-27

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摘要： 目的 探讨提高挽救性淋巴结清扫术对于生化复发前列腺癌患者的治疗效果。 方法 2015~2017年我院收治并接受前列腺特异性膜抗原(PSMA)单光子发射计算机化断层显像(SPECT)/CT检查引导下行挽救性淋巴结清扫术的前列腺癌患者,对其中3例典型患者进行回顾性分析。 结果 病例1行前列腺癌根治术(RP)后,前列腺特异性抗原(PSA)再次升高,PSMA SPECT/CT示左侧髂总血管旁肿大淋巴结,遂行双侧扩大盆腔淋巴结清扫术,术后患者PSA下降至0.2 ng/mL以下,维持8个月后再次升高;病例2 RP患者术后PSA再次升高为22 ng/mL,PSMA SPECT/CT示腹膜后淋巴结肿大,遂行腹膜后淋巴结清扫术,术后PSA逐渐下降,3个月后最低至10 ng/mL,随后再次反弹;病例3行前列腺癌根治性放疗,患者PSA下降后逐渐升至4 ng/mL,PSMA SPECT/CT示右侧髂血管旁放射性摄取增高灶,遂行扩大盆腔淋巴结清扫术+放疗,PSA下降至0.2 ng/mL以下,维持14个月后逐渐升高。 结论 对于生化复发前列腺癌患者,若PSA水平较低且出现孤立淋巴结转移灶,PSMA SPECT/CT引导下的挽救性淋巴结切除术可作为综合治疗手段之一使患者获益。

关键词: 前列腺特异性膜抗原, 前列腺癌, 转移灶, 挽救性淋巴结清扫术

Abstract: Objective To improve the value of salvage lymph node dissection for patients treated with radical prostatectomy(RP)with biochemical recurrence. Methods The clinical data of 3 typical cases treated with 99mTc-prostate-specific membrane antigen(PSMA)single photon emission computed tomography(SPECT)/CT guided salvage lymph node dissection during 2015 and 2017 were retrospectively analyzed. Results In case 1, the prostate specific antigen(PSA)control was not satisfactory after RP. PSMA SPECT/CT showed suspicious lymph node metastases near the left iliac blood vessels. After extended pelvic lymphadenectomy, the PSA level decreased to 0.2 ng/mL for 8 months and then increased again. In case 2, the PSA level increased to 22 ng/mL after RP. PSMA SPECT/CT showed suspicious retroperitoneal lymph node metastases. After retroperitoneal salvage lymph node dissection, the PSA level decreased to 10 ng/mL in 3 months and then bounced back. In case 3, after radical radiation, the PSA level gradually decreased and 山 东 大 学 学 报 (医 学 版)57卷1期 -宿恒川,等.PSMA SPECT/CT检查引导下的挽救性淋巴结清扫术在生化复发前列腺癌患者治疗中的价值 \=-then increased to 4 ng/mL. PSMA SPECT/CT showed suspicious lymph node metastases near the right iliac blood vessels. After salvage pelvic lymph node dissection plus radiation, the PSA level decreased to less than 0.2 ng/mL for 14 months and then increased. Conclusion For prostate cancer patients with biochemical recurrence, low PSA level and isolated nodal recurrence after RP, PSMA SPECT/CT guided salvage lymph node dissection can alleviate tumor burden and benefit the patients.

Key words: Prostate-specific membrane antigen, Prostate cancer, Metastatic lesions, Salvage lymph node dissection

中图分类号: 

  • R737.25
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