III 期证据表明，下一代成像 (NGI)，例如前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描 (PSMA PET/CT)，比骨扫描和对比增强计算机断层扫描（传统成像、 CI）用于中高危前列腺癌（PCa）患者的初步分期。然而，由于缺乏结果数据，将 NGI 引入常规临床实践仍存在争议。分析 NGI 抢阶段患者的肿瘤学结果（尽管根据 CI 进行管理）可能会阐明这个问题，支持随机试验的设计，比较基于 NGI 与 CI 的治疗效果。我们前瞻性地招募了 100 名活检患者的队列-经证实的中高危PCa患者采用CI和PSMA PET/CT分期（尽管根据CI分期进行管理），以评估分期迁移现象的频率。然后将分期迁移作为生化无复发生存 (bRFS) 预测因子进行评估。影像学随访后，三名患者失访。与 CI 相比，PSMA PET/CT 降低了 26.8% 的患者分期，同时降低了 6.1% 的患者分期。值得注意的是，如果 PSMA PET/CT 指导治疗选择，50% 由于 CI 存在骨转移而被排除在手术之外的患者将接受根治性方法治疗。对接受手术治疗的患者进行中位随访 6 个月后，22/83 (26.5%) 的患者出现生化复发 (BCR)。 PSMA PET/CT 驱动的升期确定 BCR 风险显着增加（HR：3.41，95％CI：1.21-9.56，p = 0.019）。将分期迁移纳入单变量和多变量模型中，将 PSMA PET/CT 分期确定为 bRFS 的独立预测因子。 总之，出于分期目的实施 NGI 可以改善 bRFS 的预测。尽管仍需要 III 期证据，但这一进展表明 NGI 可以更好地识别从局部治疗中受益的患者，而不是通过全身治疗获得更好肿瘤结果的患者。© 2023。作者获得 Springer 的独家许可-德国 Verlag GmbH，隶属于施普林格自然集团。

Phase III evidence showed that next-generation imaging (NGI), such as prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT), provides higher diagnostic accuracy than bone scan and contrast-enhanced computed tomography (conventional imaging, CI) in the primary staging of intermediate-to-high-risk prostate cancer (PCa) patients. However, due to the lack of outcome data, the introduction of NGI in routine clinical practice is still debated. Analysing the oncological outcome of patients upstaged by NGI (though managed according to CI) might shed light on this issue, supporting the design of randomised trials comparing the effects of treatments delivered based on NGI vs. CI.We prospectively enrolled a cohort of 100 biopsy-proven intermediate-to-high-risk PCa patients staged with CI and PSMA PET/CT (though managed according to the CI stage), to assess the frequency of the stage migration phenomenon. Stage migration was then assessed as biochemical recurrence-free survival (bRFS) predictor.Three patients were lost at follow-up after imaging. PSMA PET/CT upstaged 26.8% of patients compared to CI, while it downstaged 6.1% of patients. Notably, 50% of patients excluded from surgery due to the presence of bone metastases at CI would have been treated with radical-intent approaches if PSMA PET/CT had guided the treatment choice. After a median follow-up of 6 months of surgically treated patients, 22/83 (26.5%) had biochemical recurrence (BCR). PSMA PET/CT-driven upstaging determined a significant risk increase for BCR (HR:3.41, 95%CI:1.21-9.56, p = 0.019). Including stage migration in a univariable and multivariable model identified PSMA PET/CT-upstaging as an independent predictor of bRFS.In conclusion, implementing NGI for staging purposes improves the prediction of bRFS. Although phase III evidence is still needed, this advancement suggests that NGI may better identify patients who would benefit from local treatments than those who may achieve better oncological outcomes through systemic treatment.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.