前列腺特异性膜抗原（PSMA）靶向正电子发射断层扫描（PET）在阳性前列腺癌（PC）患者的转移病灶检测方面具有更高的准确性。虽然PSMA PET在PC的一次性和二次性成像中占据重要地位，但目前有关其在评估晚期PC患者的治疗反应方面的数据有限。本文回顾了有关抗雄激素治疗对PSMA表达的转移部位的影响以及串联（基础和至少1个随访扫描）PSMA PET在评估转移性PC患者的治疗反应方面所扮演的角色的现行文献资料。我们在PubMed数据库中进行了全面的文献搜索，使用了“PSMA expression prostate”、“PSMA regulation”、“PSMA PET response assessment”和“serial PSMA PET”等术语。串联PSMA PET研究（基础和至少了1个随访扫描）提供了有关在经过全身性治疗后PSMA表达变化的有价值数据，这种方法用于转移性PC患者。PSMA PET检测到在激素干预后的PSMA表达反弹和上调似乎是早期事件，在治疗3个月后解决。 PSMA PET成像对选择接受177Lu-PSMA放射配体治疗（RLT）的患者至关重要。越来越多的证据支持在RLT后评估治疗反应时使用它。初步证据表明，在接受除RLT以外的系统性治疗的转移性PC患者中，PSMA PET对治疗反应的评估具有价值。抗雄激素治疗后的PSMA反弹似乎是一个早期事件，因此PET扫描不应早于治疗开始后3个月进行。 PSMA PET在根据个人患者的特定需求定制治疗和评估晚期PC患者之后的全身性治疗反应方面具有潜在作用。本综述描述了如何使用敏感的成像方法来评估转移性前列腺癌的治疗反应。版权 © 2023年欧洲泌尿学协会。由爱思唯尔公司发布。保留所有权利。

Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) has superior accuracy for detection of metastatic lesions in patients with prostate cancer (PC). Although PSMA PET has a prominent role in primary and secondary imaging of PC, data on its role in assessing treatment response in advanced PC are limited.To review current data in the literature regarding the impact of antiandrogen therapy on PSMA expression of metastatic sites and the role of serial (baseline and at least 1 follow-up scan) PSMA PET to assess treatment response in patients with metastatic PC.A comprehensive literature search in the PubMed database was performed using the terms "PSMA expression prostate", "PSMA regulation", "PSMA PET response assessment", and "serial PSMA PET".Serial PSMA PET studies (baseline and at least 1 follow-up scan) provide valuable data regarding PSMA expression changes after systemic treatment in patients with metastatic PC. PSMA PET-detected flare and upregulation of PSMA expression following hormonal intervention seem to be early events resolving after 3 mo of treatment. PSMA PET imaging is essential in selecting patients for 177Lu-PSMA radioligand therapy (RLT). Growing evidence favors its use in assessing treatment responses after RLT. Preliminary evidence indicates the value of PSMA PET for assessment of the treatment response in patients receiving systemic treatment other than RLT for metastatic PC.PSMA flare following antiandrogen therapy seems to be an early event and thus PET scans should be performed no earlier than 3 mo after the start of treatment. PSMA PET has a promising role in tailoring treatment according to the specific needs of individual patients and assessing responses following systemic treatment in patients with advanced PC.This review describes how a sensitive imaging method can be used to assess the tumor response to treatment for metastatic prostate cancer.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.