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Papel da PET-PSMA no Cancro da Próstata – Relevância no Diagnóstico, Estadiamento e Seguimento
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Advisor(s)
Abstract(s)
Introdução: O cancro da próstata (CaP) é uma das neoplasias mais prevalentes no
sexo masculino e uma das principais causas de morte por cancro nesta população. O
antigénio de membrana prostático específico (PSMA) apresenta especificidade para as
células do CaP, pelo que tem merecido um papel de destaque na comunidade científica.
A PET-PSMA apresenta elevada precisão diagnóstica nos diversos estadios do CaP. A
sua utilização na recidiva bioquímica (BCR) é o exemplo mais evidente, apresentando
elevadas sensibilidade e especificidade, mesmo para valores de antigénio prostático
específico (PSA) baixos, comparativamente com os métodos convencionais. Apesar dos
resultados promissores nas diversas fases do CaP, os métodos convencionais
permanecem o gold-standard, sendo que a sua utilização apenas está contemplada nas
guidelines da European Association of Urology (EAU) para a BCR.
Objetivos: O objetivo deste trabalho passa por compreender qual a relevância da PETPSMA nas diversas fases do cancro da próstata (nomeadamente o diagnóstico,
estadiamento, acompanhamento, seguimento e tratamento), quais as suas vantagens e
desvantagens relativamente aos métodos convencionais e em que patamar se encontra
a comunidade científica relativamente a este tema.
Metodologia: A pesquisa bibliográfica foi realizada na base de dados PubMed, entre
agosto de 2023 e agosto de 2024, incluiu artigos em língua inglesa, com limitação
temporal de 10 anos (2014-2024). Após uma análise detalhada dos artigos selecionados
inicialmente, foram escolhidos os mais relevantes para o tema. Foi realizada uma
análise minuciosa das referências dos próprios artigos utilizados, de forma a garantir
que outras publicações pertinentes fossem facilmente encontradas e incluídas na
dissertação.
Discussão e conclusões: A PET-PSMA evidenciou capacidade superior à
ressonância magnética multiparamétrica (RMNmp) na deteção de lesões primárias e
secundárias, com menores taxas de falsos positivos e maior precisão diagnóstica. No
estadiamento ganglionar e na deteção de metástases à distância, a PET-PSMA superou
os métodos convencionais, como a tomografia computorizada (CT) e a cintigrafia óssea,
mesmo em condições de baixos valores de PSA, onde os métodos convencionais podem
negligenciar a doença metastática. No entanto, a utilização deste método está apenas
validada e introduzida nas guidelines da EAU para a deteção de recidiva na BCR. Torna-se, desta forma, essencial a manutenção da investigação nesta área, tendo em
conta a superior capacidade evidenciada pela PET-PSMA até ao momento.
Introduction: Prostate cancer (CaP) is one of the most prevalent malignancies in males and a leading cause of cancer-related death in this population. Prostate-specific membrane antigen (PSMA) shows specificity for CaP cells, earning a prominent role in the scientific community. PET-PSMA demonstrates high diagnostic accuracy across various stages of prostate cancer. Its use in biochemical recurrence (BCR) is the most evident example, showing high sensitivity and specificity, even at low prostate-specific antigen (PSA) levels, compared to conventional methods. Despite promising results across the different stages of CaP, its use is only included in the European Urological Association (EAU) guidelines for BCR, while conventional methods remain the gold standard. Objectives: The aim of this work is to understand the relevance of PET-PSMA across different stages of prostate cancer: diagnosis, staging, monitoring, follow-up, and treatment. It also seeks to evaluate its advantages and disadvantages compared to conventional methods and assess the current scientific community's stance on the subject. Methodology: The literature review was conducted using the PubMed database, from August 2023 to August 2024, including English-language articles within a 10-year time frame (2014-2024). After a detailed analysis of the initially selected articles, the most relevant ones for the topic were chosen. A thorough review of the references in these articles was also conducted to ensure that other pertinent publications could be easily found and included in the dissertation. Discussion and conclusions: PET-PSMA demonstrated superior capability to multiparametric magnetic resonance imaging (mpMRI) in detecting primary and secondary lesions, with lower false-positive rates and greater diagnostic accuracy. In nodal staging and detection of distant metastases, PET-PSMA outperformed conventional methods, such as computed tomography (CT) and bone scintigraphy, even in low PSA conditions, where conventional methods may overlook metastatic disease. However, the use of this method is currently only validated and included in the European Urological Association (EAU) guidelines for recurrence detection in BCR. Thus, continued research in this area is essential, given the superior capability PETPSMA has demonstrated so far.
Introduction: Prostate cancer (CaP) is one of the most prevalent malignancies in males and a leading cause of cancer-related death in this population. Prostate-specific membrane antigen (PSMA) shows specificity for CaP cells, earning a prominent role in the scientific community. PET-PSMA demonstrates high diagnostic accuracy across various stages of prostate cancer. Its use in biochemical recurrence (BCR) is the most evident example, showing high sensitivity and specificity, even at low prostate-specific antigen (PSA) levels, compared to conventional methods. Despite promising results across the different stages of CaP, its use is only included in the European Urological Association (EAU) guidelines for BCR, while conventional methods remain the gold standard. Objectives: The aim of this work is to understand the relevance of PET-PSMA across different stages of prostate cancer: diagnosis, staging, monitoring, follow-up, and treatment. It also seeks to evaluate its advantages and disadvantages compared to conventional methods and assess the current scientific community's stance on the subject. Methodology: The literature review was conducted using the PubMed database, from August 2023 to August 2024, including English-language articles within a 10-year time frame (2014-2024). After a detailed analysis of the initially selected articles, the most relevant ones for the topic were chosen. A thorough review of the references in these articles was also conducted to ensure that other pertinent publications could be easily found and included in the dissertation. Discussion and conclusions: PET-PSMA demonstrated superior capability to multiparametric magnetic resonance imaging (mpMRI) in detecting primary and secondary lesions, with lower false-positive rates and greater diagnostic accuracy. In nodal staging and detection of distant metastases, PET-PSMA outperformed conventional methods, such as computed tomography (CT) and bone scintigraphy, even in low PSA conditions, where conventional methods may overlook metastatic disease. However, the use of this method is currently only validated and included in the European Urological Association (EAU) guidelines for recurrence detection in BCR. Thus, continued research in this area is essential, given the superior capability PETPSMA has demonstrated so far.
Description
Keywords
Cancro da Próstata Diagnóstico Estadiamento Rastreio Seguimento Pet/Ct Psma Tratamento