Gacci Mauro, Cai Tommaso, Siena Giampaolo, Minervini Andrea, Torshizi Mozhgan Fayaz, Bartolini Matteo, Giannì Gianluca, Saieva Calogero, Ceroti Mauro, Detti Beatrice, Livi Lorenzo, Pupi Alberto, Carini Marco
Department of Urology.
Scand J Urol. 2014 Jun;48(3):259-67. doi: 10.3109/21681805.2013.846936. Epub 2013 Nov 21.
The aim of this study was to identify prostate-specific antigen (PSA) kinetics parameters predictive of [(18)F]fluorocholine positron emission tomography/computed tomography ((18)FC PET/CT) features worsening in a cohort of patients with biochemical failure after prostate cancer treatment.
This longitudinal cohort study comprised 103 consecutive patients. All patients underwent two (18)FC PET/CT scans: one at baseline (PET1) and one after 6 months (PET2). Total PSA (tPSA), PSA velocity (vPSA), PSA doubling time (PSAdt), absolute variation in PSA values between PET2 and PET1 (ΔPSA), and percentage variation in PSA between the two PSA measurements (PSA%) were measured in each patient. Progression of disease on (18)FC PET/CT findings was compared with the PSA kinetics parameters. The major outcome measure was disease progression at PET2.
(18)FC PET/CT progression between PET1 and PET2 was reported in 64 patients (62.1%), while in 39 cases it remained unvaried. The following PSA kinetic parameters correlated with worsened (18)FC PET/CT findings: ΔPSA >5 ng/ml [odds ratio (OR = 6.44, 95% confidence interval (CI) 1.04-39.6; p = 0.04], vPSA >6 ng/ml/month (OR = 5.2, 95% CI 0.9-29.8; p = 0.05) and PSAdt <6 months (OR = 5.2, 95% CI 0.4-5.4; p = 0.03). From receiver operating characteristics (ROC) analysis, the combination with the three PSA kinetics parameters for predicting worsened (18)FC PET/CT findings resulted in a sensitivity of 86% (95% CI 77-92%) and specificity of 77% (95% CI 65-85%).
PSA kinetics is strictly related to (18)FC PET/CT findings. In patients with biochemical relapse, ΔPSA >5 ng/ml, PSAdt <6 months and vPSA >6 ng/ml/month are highly predictive of (18)FC PET/CT features worsening, independently from the treatment received.
本研究旨在确定前列腺特异性抗原（PSA）动力学参数，以预测前列腺癌治疗后生化复发患者队列中[（18）F]氟胆碱正电子发射断层扫描/计算机断层扫描（（18）FC PET/CT）特征的恶化情况。
这项纵向队列研究包括103例连续患者。所有患者均接受两次（18）FC PET/CT扫描：一次在基线时（PET1），一次在6个月后（PET2）。测量每位患者的总PSA（tPSA）、PSA速度（vPSA）、PSA倍增时间（PSAdt）、PET2和PET1之间PSA值的绝对变化（ΔPSA）以及两次PSA测量之间PSA的百分比变化（PSA%）。将（18）FC PET/CT检查结果的疾病进展与PSA动力学参数进行比较。主要观察指标是PET2时的疾病进展。
64例患者（62.1%）报告了PET1和PET2之间（18）FC PET/CT进展，而39例患者无变化。以下PSA动力学参数与（18）FC PET/CT检查结果恶化相关：ΔPSA>5 ng/ml [比值比（OR）=6.44，95%置信区间（CI）1.04 - 39.6；p = 0.04]，vPSA>6 ng/ml/月（OR = 5.2，95%CI 0.9 - 29.8；p = 0.05）和PSAdt<6个月（OR = 5.2，95%CI 0.4 - 5.4；p = 0.03）。根据受试者工作特征（ROC）分析，结合这三个PSA动力学参数预测（18）FC PET/CT检查结果恶化的敏感性为86%（95%CI 77 - 92%），特异性为77%（95%CI 65 - 85%）。
PSA动力学与（18）FC PET/CT检查结果密切相关。在生化复发患者中，ΔPSA>5 ng/ml、PSAdt<6个月和vPSA>6 ng/ml/月高度预测（18）FC PET/CT特征恶化，与所接受的治疗无关。
