Division of Nuclear Medicine, Department of Radiology, Kenneth J. Norris Jr. Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
Clin Nucl Med. 2012 Jul;37(7):637-43. doi: 10.1097/RLU.0b013e318252d829.
This study aimed to perform a prospective evaluation of 18F-NaF and 18F-FDG PET/CT in the detection of occult metastatic disease in men with prostate cancer and biochemical relapse.
Thirty-seven men with prostate-specific antigen (PSA) relapse (median, 3.2 ng/mL; range, 0.5-40.2 ng/mL) after definitive therapy for localized prostate cancer [26 radical prostatectomy (RP), 11 external beam radiation therapy] and negative conventional imaging underwent 18F-FDG and 18F-NaF PET/CT on 2 separate days within the same week. Studies were interpreted by 2 experienced radiologists in consensus for abnormal uptake suspicious for metastatic disease. The reference standard was a combination of imaging and clinical follow-up. Rank of PSA values for positive and negative PET/CT was compared using analysis of variance adjusting for primary therapy. Association between PSA and scan positivity in patients with RP was evaluated using Wilcoxon rank sum test.
Result of the 18F-FDG PET/CT scan was positive for nodal disease in 2 patients. True-positive detection rate for occult osseous metastases by 18F-NaF PET/CT was 16.2%. Median PSA levels for positive versus negative PET/CT scans were 4.4 and 2.9 ng/mL, respectively, with the difference marginally significant in prostatectomized men (P=0.072). Percentages of patients with either 18F-NaF- or 18F-FDG-positive PET/CT in RP and external beam radiation therapy were 10% (n=10) and undefined (n=0) for a PSA of 2 ng/mL or less, 29% (n=7) and 50% (n=2) for PSA greater than 2 ng/mL but 4 ng/mL or less, 60% (n=5) and 40% (n=5) for PSA greater than 4 ng/mL but 10 ng/mL or less, and 25% (n=4) and 25% (n=4) for PSA greater than 10 ng/mL, respectively.
In biochemical relapse of prostate cancer, 18 F-NaF PET/CT is useful in the detection of occult osseous metastases, whereas the yield of 18F-FDG PET/CT is relatively limited. 18F-NaF PET/CT positivity tends to associate with increasing PSA level in prostatectomized men and may occur in lower PSA ranges than conventionally recognized.
本研究旨在前瞻性评估 18F-NaF 和 18F-FDG PET/CT 在检测局部前列腺癌根治性治疗后生化复发伴隐匿性转移疾病中的作用。
37 例前列腺特异性抗原（PSA）复发（中位数为 3.2ng/ml；范围为 0.5-40.2ng/ml）的男性患者接受了根治性治疗[26 例前列腺根治切除术（RP），11 例外照射]，且常规影像学检查阴性，在同一周内分两天进行 18F-FDG 和 18F-NaF PET/CT。由 2 名经验丰富的放射科医生对研究结果进行解读，评估摄取异常是否疑似转移病灶。参考标准为影像学检查与临床随访相结合。使用方差分析调整主要治疗方法对阳性和阴性 PET/CT 的 PSA 值进行排序比较。采用 Wilcoxon 秩和检验评估 RP 患者 PSA 值与扫描阳性的相关性。
2 例患者的 18F-FDG PET/CT 扫描结果显示存在淋巴结疾病。18F-NaF PET/CT 检测隐匿性骨转移的真阳性检出率为 16.2%。阳性与阴性 PET/CT 扫描的 PSA 中位数分别为 4.4ng/ml 和 2.9ng/ml，RP 患者的 PSA 水平差异具有统计学意义（P=0.072）。PSA 值为 2ng/ml 或以下时，18F-NaF 或 18F-FDG-PET/CT 阳性患者比例分别为 10%（n=10）和未定义（n=0），PSA 值大于 2ng/ml 但小于或等于 4ng/ml 时，阳性患者比例分别为 29%（n=7）和 50%（n=2），PSA 值大于 4ng/ml 但小于或等于 10ng/ml 时，阳性患者比例分别为 60%（n=5）和 40%（n=5），PSA 值大于 10ng/ml 时，阳性患者比例分别为 25%（n=4）和 25%（n=4）。
在前列腺癌的生化复发中，18F-NaF PET/CT 对检测隐匿性骨转移有帮助，而 18F-FDG PET/CT 的检出率相对有限。在接受 RP 治疗的男性中，18F-NaF PET/CT 阳性与 PSA 水平的升高有关，且可能出现在传统上认为的更低的 PSA 范围内。
