空格結果≧75%（達到St. Gallen共識）標示黃底紅字；空格結果≧50%標示紅字。
Topic 6.
Imaging in APC
第三次
臺灣晚期攝護腺癌專家共識
3 rd Taiwan Advanced Prostate Cancer Consensus
117
In which men with isolated rising PSA alone after prostatectomy do you recommend imaging (including next generation imaging) before starting salvage radiation therapy?
Survey URO RO MO High Vol Senior UO
N Option 1 Option 2 Option 3 Option 4 Option 5
175 44%
20%
9%
24%
3%
46 59%
32%
5%
5%
0%
30 48%
10%
10%
33%
0%
96 49%
23%
10%
15%
3%
95 45%
22%
7%
23%
4%
30 45%
24%
10%
21%
0%
Survey Panelists 199
47%
22%
8%
21%
2%
52
38 79%
11%
0 8%
3%
1
Responders
1. In the majority of patients, independent of PSA level 2. Only in patients with PSA >0.5 ng/mL
3. Only in patients with PSA >1 ng/mL 4. Only in patients with PSA >2 ng/mL 5. No imaging
Non-responder, abstain, unqualified to answer
St.Gallen 47 45%
30%
13%
13%
0 1
2017 EAU Guideline建議，high baseline PSA (>10 ng/ml) or PSADT<6 mo的post RP/RT rising PSA的病人，應該要做bone scan和腹部CT了。若是病人的PSA<7 ng/ml，bone scan的positive rate <5%。當PSA value <1 ng/ml時，Choline PET/CT的sensitivity 也相 當低 (Yu et al., J Urol 2012)。
因此國內專家傾向在給予salvage RT前，先照影像學。但是若打算做local salvage ther- apy 時，可能需要second generation image，來確認真的只有local recurrence，及排除 distant metastasis。
但是在給予adjuvant RT之前，由於PSA相當低，甚至undetectable，因此，大部分醫師認 為不需要做影像學檢查。但是有些專家對與給予此類病人adjuvant RT之前，可能會採取 非必要的預防性醫療，而進行影像學檢查。
118
Q6-1
•評論分析：
Q6-2
What monitoring by imaging do you recommend for the majority of men with metastatic castration-sensitive/naive prostate cancer?
Survey URO RO MO High Vol Senior UO
N Option 1 Option 2 Option 3
175 16%
39%
46%
46 8%
37%
55%
30 21%
58%
21%
96 15%
33%
52%
51 31%
51%
18%
0
95 10%
31%
59%
30 14%
31%
55%
Survey Panelists 197
15%
41%
45%
54
38 0
34%
66%
1
Responders
1. Baseline imaging and regular monitoring by imaging every 3-6 months
2. Baseline imaging and follow-up imaging at PSA nadir/completion of 6 cycles of Docetaxel as part of chemo-hormonal therapy and again at progression (confirmed PSA rise and/or clinical progression) 3. Baseline imaging only and monitoring by PSA alone and imaging at progression
Non-responder, abstain, unqualified to answer
有較多的國外專家已經在mHSPC的病患，開始使用upfront chemo treatment。因此在 mHSPC階段的影像，會在upfront chemo treatment前後皆照。國內專家則是只在baseline 的建立，以及等到PSA progression後，再照影像學確定disease progression。
•評論分析：
St.Gallen
119
Q6-3
What monitoring by imaging do you recommend for the majority of men on first-line mCRPC therapy?
Survey URO RO MO High Vol Senior UO
N Option 1 Option 2 Option 3
175 30%
36%
34%
46 11%
39%
50%
30 15%
65%
19%
96 33%
34%
33%
49 54%
28%
16%
1
95 22%
35%
43%
30 41%
31%
28%
Survey Panelists 196
24%
40%
35%
55
38 21%
24%
55%
1
Responders
1. Baseline imaging and regular monitoring by imaging every 3-6 months
2. Baseline imaging and follow-up imaging at PSA nadir/completion of 6 cycles of Docetaxel as part of chemo-hormonal therapy and again at progression (confirmed PSA rise and/or clinical progression) 3. Baseline imaging only and monitoring by PSA alone and imaging at progression
Non-responder, abstain, unqualified to answer
在監控mCRPC治療的階段，五成國外專家偏向3-6個月規律性的影像學監控。但是由 於健保的規範，在台灣實行規律性的影像學監控上有困難。由於現在申請使用或續用 novel AR targeted agents都要附上影像學證明。所以部分的國內專家也開始會每3-6個 月規律的使用影像學。約半數的國內專家還是會到PSA progression後，再照影像學確定 disease progression。
•評論分析：
St.Gallen
120
