Background: Local recurrences following radical prostatectomy (RP) are typically attributed to incomplete surgical resection or positive surgical margins (PSMs). Yet approximately 70% of men with PSMs never experience BCR. Prostate-specific membrane antigen PET scans (PSMA PET) are useful in detecting the incidence and location of recurrence sites. This study explores the relationship between margin status and local and metastatic recurrences using PSMA PET scans.Methods: A retrospective study was conducted with prospectively collected data following RARP with BCR in 159 men undergoing PSMA PET (2017–2023). The primary outcome compared risk and location of recurrences between NSM vs. PSM. A total of 13 cases (8%) had “equivocal” PET scan findings which were assessed first as all positive and then all negative.Results: Of 159 men with BCR undergoing PSMA PET scans, 101 (63.5%) had NSMs and 58 (36.5%) had PSMs. Assuming all 13 “equivocal” scans were positive, the risk of a positive PSMA PET is NSMs vs. PSMs (73% vs. 69%p= 0.56). Local recurrence rates did not differ significantly (NSMs 39.2% vs. PSMs 45%p= 0.55), nor did lymph nodes (NSMs 61% vs. PSMs 58%p= 0.73) or bone lesions (NSMs 16.2% vs. PSMs 22.5%p= 0.41). Multivariate regression analysis showed that margin status was not a predictor of local recurrence (OR 1.40; 95% CI [0.65, 1.54];p= 0.382).Conclusions: Local recurrence occurs at about the same rate independent of margin positivity status, suggesting that local recurrences appear to be more closely related to metastatic dissemination, not incomplete resection. These findings question the oncologic rationale for wider resections at the expense of functional outcomes.
背景：根治性前列腺切除术（RP）后的局部复发通常归因于手术切除不彻底或切缘阳性（PSMs）。然而，约70%的切缘阳性患者从未出现生化复发（BCR）。前列腺特异性膜抗原正电子发射断层扫描（PSMA PET）有助于检测复发灶的发生率和位置。本研究利用PSMA PET探讨了切缘状态与局部及远处转移复发之间的关系。 方法：本研究为回顾性研究，前瞻性收集了2017年至2023年间159例接受机器人辅助根治性前列腺切除术（RARP）后出现BCR并接受PSMA PET检查的男性患者数据。主要结局是比较切缘阴性（NSM）与切缘阳性（PSM）患者之间的复发风险和复发部位。共有13例（8%）患者的PET扫描结果为"不确定"，分析时首先将其全部视为阳性，随后全部视为阴性进行评估。 结果：在159例接受PSMA PET检查的BCR患者中，101例（63.5%）为切缘阴性，58例（36.5%）为切缘阳性。假设所有13例"不确定"扫描均为阳性，则PSMA PET阳性风险在切缘阴性组与切缘阳性组之间无显著差异（73% vs. 69%，p=0.56）。局部复发率（切缘阴性组39.2% vs. 切缘阳性组45%，p=0.55）、淋巴结复发率（切缘阴性组61% vs. 切缘阳性组58%，p=0.73）及骨转移率（切缘阴性组16.2% vs. 切缘阳性组22.5%，p=0.41）均无显著差异。多变量回归分析显示，切缘状态并非局部复发的预测因素（OR 1.40；95% CI [0.65, 1.54]；p=0.382）。 结论：无论切缘状态如何，局部复发率大致相同，这表明局部复发似乎与肿瘤转移播散的关系更为密切，而非手术切除不彻底。这些发现对以牺牲功能结局为代价进行更广泛切除的肿瘤学依据提出了质疑。
肿瘤(癌症)患者之家