Osborne Joseph R, Green David A, Spratt Daniel E, Lyashchenko Serge, Fareedy Shoaib B, Robinson Brian D, Beattie Bradley J, Jain Manu, Lewis Jason S, Christos Paul, Larson Steven M, Bander Neil H, Scherr Douglas S
Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
Department of Urology, Weill Medical College of Cornell University, New York, New York.
J Urol. 2014 May;191(5):1439-45. doi: 10.1016/j.juro.2013.10.041. Epub 2013 Oct 14.
In this pilot study we explored the feasibility of (89)Zr labeled J591 monoclonal antibody positron emission tomography of localized prostate cancer.
Before scheduled radical prostatectomy 11 patients were injected intravenously with (89)Zr-J591, followed 6 days later by whole body positron emission tomography. Patients underwent surgery the day after imaging. Specimens were imaged by ex vivo micro positron emission tomography and a custom 3 Tesla magnetic resonance scanner coil. Positron emission tomography images and histopathology were correlated.
Median patient age was 61 years (range 47 to 68), median prostate specific antigen was 5.2 ng/ml (range 3.5 to 12.0) and median biopsy Gleason score of the 11 index lesions was 7 (range 7 to 9). On histopathology 22 lesions were identified. Median lesion size was 5.5 mm (range 2 to 21) and median Gleason score after radical prostatectomy was 7 (range 6 to 9). Eight of 11 index lesions (72.7%) were identified by in vivo positron emission tomography. Lesion identification improved with increasing lesion size for in vivo and ex vivo positron emission tomography (each p <0.0001), and increasing Gleason score (p = 0.14 and 0.01, respectively). Standardized uptake values appeared to correlate with increased Gleason score but not significantly (p = 0.19).
To our knowledge this is the first report of (89)Zr-J591/prostate specific membrane antigen positron emission tomography in localized prostate cancer cases. In this setting (89)Zr-J591 bound to tumor foci in situ and positron emission tomography identified primarily Gleason score 7 or greater and larger tumors, likely corresponding to clinically significant disease warranting definitive therapy. A future, larger clinical validation trial is planned to better define the usefulness of (89)Zr-J591 positron emission tomography for localized prostate cancer.
在这项初步研究中，我们探讨了用（89）Zr标记的J591单克隆抗体对局限性前列腺癌进行正电子发射断层扫描的可行性。
在预定的根治性前列腺切除术之前，11例患者静脉注射（89）Zr-J591，6天后进行全身正电子发射断层扫描。患者在成像后第二天接受手术。标本通过离体微型正电子发射断层扫描和定制的3特斯拉磁共振扫描仪线圈进行成像。正电子发射断层扫描图像与组织病理学结果进行关联。
患者中位年龄为61岁（范围47至68岁），中位前列腺特异性抗原为5.2 ng/ml（范围3.5至12.0），11个索引病灶的中位活检Gleason评分为7（范围7至9）。组织病理学检查发现22个病灶。病灶中位大小为5.5 mm（范围2至21），根治性前列腺切除术后的中位Gleason评分为7（范围6至9）。11个索引病灶中有8个（72.7%）通过体内正电子发射断层扫描得以识别。体内和离体正电子发射断层扫描的病灶识别率均随病灶大小增加而提高（均p<0.0001），且随Gleason评分增加而提高（分别为p = 0.14和0.01）。标准化摄取值似乎与Gleason评分增加相关，但无显著相关性（p = 0.19）。
据我们所知，这是关于（89）Zr-J591/前列腺特异性膜抗原正电子发射断层扫描在局限性前列腺癌病例中的首次报告。在此情况下，（89）Zr-J591原位结合肿瘤病灶，正电子发射断层扫描主要识别出Gleason评分为7分或更高以及较大的肿瘤，可能对应需要确定性治疗的具有临床意义的疾病。计划开展一项更大规模的未来临床验证试验，以更好地确定（89）Zr-J591正电子发射断层扫描对局限性前列腺癌的有用性。
