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Authors
Advisor(s)
Abstract(s)
No Carcinoma da próstata (CaP) estima-se que 40% dos doentes, após prostatectomia radical, sofrem recidiva bioquímica, traduzido pelo aumento do Prostate-Specific Antigen (PSA). Ainda subsiste controvérsia relativamente ao diagnóstico subjacente e, aproximadamente, 50% dos doentes são propostos a radioterapia de salvação erroneamente. Esta abordagem resulta em custos elevados e prejuízos associados a um tratamento sem benefício, com efeitos secundários agressivos que potenciam atraso no tratamento. A Positron Emission Tomography (PET)/ Computer Tomography (CT) com 68Ga-Prostate-Specific Membrane Antigen (PSMA) é a técnica de imagem mais promissora no diagnóstico de recidiva bioquímica, permitindo detetar lesões com maior sensibilidade e especificidade, definindo um estadiamento mais preciso e precoce e auxiliando na decisão da terapêutica mais adequada. Objetivo: Avaliar o custo-efetividade da PET/CT com 68Ga-PSMA nos doentes de CaP em recidiva bioquímica após prostatectomia radical comparativamente à cintigrafia óssea. Metodologia: Estudo retrospetivo, desenvolvido na Unidade de Medicina Nuclear do Hospital Lusíadas Lisboa, constituído por uma amostra de 36 doentes: 17 realizaram a PET/CT com 68Ga-PSMA e 19 cintigrafia óssea. Procedeu-se à valorização dos custos e benefícios associados aos exames em estudo, e a influência na realização da radioterapia de salvação. Resultados: Dos doentes que realizaram PET/CT com 68Ga-PSMA no estadiamento do CaP, obteve-se um RCEI de 196,8 € por % de efetividade diagnóstica, com um incremento de 8,6% para obterem um benefício adicional comparativamente à cintigrafia óssea. Conclusão: A modalidade de imagem PET/CT com 68Ga-PSMA é mais efetiva comparativamente à cintigrafia óssea.
ABSTRACT - In Prostate Cancer (PC), it is estimated that 40% of patients, after radical prostatectomy, suffer biochemical recurrence, translated into an increase of the Prostate-Specific Antigen (PSA). Controversy remains regarding the underlying diagnosis and approximately 50% of patients are wrongly proposed salvage radiotherapy, resulting in high costs and losses associated with treatment without benefit, with aggressive side effects that potentiate treatment delay. Currently, Positron Emission Tomography (PET)/ Computer Tomography (CT) with 68Ga-Prostate-Specific Membrane Antigen (PSMA) is the most promising imaging technique in diagnosing biochemical recurrence. It allows lesion detection with greater sensitivity and specificity, which results in the definition of more accurate and early staging and helps decide on the most appropriate therapy for the patient. Purpose: Evaluate the cost-effectiveness of 68Ga-PSMA PET/CT in patients with PC in biochemical recurrence after radical prostatectomy compared to bone scintigraphy. Methodology: Retrospective analysis was developed at the Nuclear Medicine Unit of Hospital Lusíadas Lisboa. That came up with a sample of 36 patients: 17 performed 68Ga-PSMA PET/CT and 19 bone scintigraphy. Costs and benefits associated with the exams under study were evaluated along with the influence on the performance of salvage radiotherapy. Results: From The patients who underwent 68Ga-PSMA PET/CT in the staging of PC, presented an ICER of diagnostic effectiveness of 196.8€ per %, with an increase of 8.6% obtaining an additional benefit compared to bone scintigraphy. Conclusion: The 68Ga-PSMA PET/CT imaging technique is more effective compared to bone scintigraphy.
ABSTRACT - In Prostate Cancer (PC), it is estimated that 40% of patients, after radical prostatectomy, suffer biochemical recurrence, translated into an increase of the Prostate-Specific Antigen (PSA). Controversy remains regarding the underlying diagnosis and approximately 50% of patients are wrongly proposed salvage radiotherapy, resulting in high costs and losses associated with treatment without benefit, with aggressive side effects that potentiate treatment delay. Currently, Positron Emission Tomography (PET)/ Computer Tomography (CT) with 68Ga-Prostate-Specific Membrane Antigen (PSMA) is the most promising imaging technique in diagnosing biochemical recurrence. It allows lesion detection with greater sensitivity and specificity, which results in the definition of more accurate and early staging and helps decide on the most appropriate therapy for the patient. Purpose: Evaluate the cost-effectiveness of 68Ga-PSMA PET/CT in patients with PC in biochemical recurrence after radical prostatectomy compared to bone scintigraphy. Methodology: Retrospective analysis was developed at the Nuclear Medicine Unit of Hospital Lusíadas Lisboa. That came up with a sample of 36 patients: 17 performed 68Ga-PSMA PET/CT and 19 bone scintigraphy. Costs and benefits associated with the exams under study were evaluated along with the influence on the performance of salvage radiotherapy. Results: From The patients who underwent 68Ga-PSMA PET/CT in the staging of PC, presented an ICER of diagnostic effectiveness of 196.8€ per %, with an increase of 8.6% obtaining an additional benefit compared to bone scintigraphy. Conclusion: The 68Ga-PSMA PET/CT imaging technique is more effective compared to bone scintigraphy.
Description
Mestrado em Gestão e Avaliação de Tecnologias em Saúde
Keywords
Carcinoma da próstata Recidiva bioquímica Prostatectomia radical Custo-efetividade PET-CT 68Ga-PSMA Prostate cancer Biochemical recurrence Radical prostatectomy Cost-effectiveness 68Ga-PSMA PET-CT
Citation
Queirós CC. Análise do custo-efetividade da PET/CT com 68Ga-PSMA nos doentes de carcinoma da próstata em recidiva bioquímica após prostatectomia radical [dissertation]. Lisboa: Escola Superior de Tecnologia da Saúde de Lisboa/Instituto Politécnico de Lisboa; Escola Superior de Saúde da Universidade do Algarve; 2022.
Publisher
Instituto Politécnico de Lisboa, Escola Superior de Tecnologia da Saúde de Lisboa