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DOI: 10.1055/s-0028-1098914
© Georg Thieme Verlag Stuttgart ˙ New York
Erste Ergebnisse der PET / CT-gesteuerten sekundären Lymphknotenchirurgie bei Patienten mit PSA-Anstieg nach radikaler Prostatektomie
First Results of PET / CT-Guided Secondary Lymph Node Surgery on Patients with a PSA Relapse after Radical ProstatectomyPublication History
Publication Date:
16 June 2009 (online)
Zusammenfassung
Fragestellung: Computer- und Magnetresonanztomografie sind zur frühen Detektion von kleinen Lymphknoten(LK)-Rezidiven beim Prostatakarzinom ungeeignet. Die neueste PET / CT (11C-, 18F-Cholin)-Technik erfasst bereits kleinere Läsionen (≥ 5 mm) und ermöglicht die topografische Zuordnung. Wir überprüften positive 11C-Cholin-PET / CT-LK-Befunde bei PSA-Anstieg nach radikaler Prostatektomie (RPE) histologisch und dokumentierten den PSA-Verlauf.Material und Methoden: Untersucht wurden 8 Patienten mit PSA-Rezidiv nach RPE und im 11C-Cholin-PET / CT diagnostizierten LK-Metastasen ohne Lokalrezidiv oder Fernmetastasen. Die im PET-CT metastasensuspekten und benachbarte LK wurden offen operativ entfernt. Histologischer und PET / CT-Befund wurden verglichen und der postoperative PSA-Verlauf erfasst. Ergebnisse: Von den im PET / CT metastasensuspekten LK (11) wurden 9 histologisch bestätigt. Alle zusätzlich entfernten LK (12) waren richtig negativ. Die LK-Metastasen lagen größtenteils (7 von 9) im Iliaca-interna-Gebiet und pararektal. 6 von 7 Patienten mit histologischem Metastasennachweis zeigten ein PSA-Ansprechen. Drei von 6 Patienten mit solitärer Metastase hatten eine komplette PSA-Remission (< 0,01 ng / ml) ohne adjuvante Therapie (maximale Nachbeobachtung 28 Monate). Bei einem Patienten mit inkompletter Remission wurde später ein Lokalrezidiv nachgewiesen.Schlussfolgerung: Die 11C-Cholin-PET / CT konnte hier die LK-Metastasen mit hoher Spezifität detektieren. Diese liegen häufig außerhalb des Standard-LA-Gebietes, wo sie primär allenfalls eine ausgedehnte bzw. Sentinel-LA erfassen kann. Da bei 3 Patienten mit solitärer LK-Metastase durch die sekundäre Metastasenchirurgie eine komplette bleibende PSA-Remission (< 0,01 ng / ml) ohne adjuvante Therapie erreicht wurde, scheint es so, dass zumindest dieses spezielle Patientenkollektiv von der operativen Behandlung profitiert hat. Ob einzelne Patienten operativ geheilt werden können, wird erst der Langzeitverlauf zeigen. Grundvoraussetzung dafür ist eine optimale Bildgebung und Erfahrung in der LK-Chirurgie.
Abstract
Purpose: CT and MRT are not applicable for the early detection of lymph node (LN) recurrence in prostate cancer. The PET / CT (11C-, 18F-choline) technique can detect lesions ≥ 5 mm and allows their topographic localisation. We have analysed positive 11C-choline PET / CT LN findings in the case of a PSA increase after radical prostatectomy (RPE) histologicaly and documented the developing of PSA. Materials and Methods: 8 patients with PSA relapse after RPE and lymphadenedtomy (LA) were diagnosed as having LNM by means of 11C-choline PET / CT. Using PET / CT, metastasis suspicious and nearby LN were openly dissected. Histological and PET / CT results were compared and the postoperative PSA-development was examined. Results: Of the metastasis suspicious LN (11) 9 were histologically reconfirmed. All additionally removed LN (12) were correct negative. LNM were mostly (7 of 9) located in the iliaca interna area and pararectal. 6 of 7 patients with histological metastasis detection showed a PSA response. 3 of 6 patients with single metastasis had complete PSA remission (< 0.01 ng / ml, maximum follow-up: 28 months) without adjuvant therapy. Conclusions: 11 C-choline PET / CT could detect LNM with high specificity in our collective. These often lie beyond standard LA area, where they were primarily only resected by use of extended or sentinel LA. Because 3 patients with single LNM reached a complete PSA remission (< 0.01 ng / ml) without adjuvant therapy, the selected collective seems to benefit from secondary LN surgery. Whether or not individual patients can be cured by this surgery has to be demonstrated in a longitudinal study. However, an optimal imaging and experience in LN surgery have to be assured.
Schlüsselwörter
Prostatakarzinom - 11C-Cholin PET / CT - Lymphknotenrezidiv - biochemisches Rezidiv - sekundäre Lymphknotenchirurgie
Key words
prostate cancer - 11C-choline PET / CT - lymph node recurrence - prostate-specific antigen relapse - secondary lymph node surgery
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Dr. A. Winter
Klinik für Urologie und Kinderurologie · Klinikum Oldenburg
Rahel-Straus-Str. 10
26133 Oldenburg
Phone: 04 41 / 4 03 23 02
Email: winter.alexander@klinikum-oldenburg.de