Afshar-Oromieh Ali, Avtzi Eleni, Giesel Frederik L, Holland-Letz Tim, Linhart Heinz G, Eder Matthias, Eisenhut Michael, Boxler Silvan, Hadaschik Boris A, Kratochwil Clemens, Weichert Wilko, Kopka Klaus, Debus Jürgen, Haberkorn Uwe
Department of Nuclear Medicine, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany,
Eur J Nucl Med Mol Imaging. 2015 Feb;42(2):197-209. doi: 10.1007/s00259-014-2949-6. Epub 2014 Nov 20.
Since the introduction of positron emission tomography (PET) imaging with (68)Ga-PSMA-HBED-CC (=(68)Ga-DKFZ-PSMA-11), this method has been regarded as a significant step forward in the diagnosis of recurrent prostate cancer (PCa). However, published data exist for small patient cohorts only. The aim of this evaluation was to analyse the diagnostic value of (68)Ga-PSMA-ligand PET/CT in a large cohort and the influence of several possibly interacting variables.
We performed a retrospective analysis in 319 patients who underwent (68)Ga-PSMA-ligand PET/CT from 2011 to 2014. Potential influences of several factors such as prostate-specific antigen (PSA) level and doubling time (DT), Gleason score (GSC), androgen deprivation therapy (ADT), age and amount of injected tracer were evaluated. Histological verification was performed in 42 patients after the (68)Ga-PSMA-ligand PET/CT. Tracer uptake was measured in 901 representative tumour lesions.
In 82.8% of the patients at least one lesion indicative of PCa was detected. Tumor-detection was positively associated with PSA level and ADT. GSC and PSA-DT were not associated with tumor-detection. The average maximum standardized uptake value (SUVmax) of tumour lesions was 13.3 ± 14.6 (0.7-122.5). Amongst lesions investigated by histology, 30 were false-negative in 4 different patients, and all other lesions (n = 416) were true-positive or true-negative. A lesion-based analysis of sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) revealed values of 76.6%, 100%, 91.4% and 100%. A patient-based analysis revealed a sensitivity of 88.1%. Of 116 patients available for follow-up, 50 received local therapy after (68)Ga-PSMA-ligand PET/CT.
(68)Ga-PSMA-ligand PET/CT can detect recurrent PCa in a high number of patients. In addition, the radiotracer is highly specific for PCa. Tumour detection is positively associated with PSA and ADT. (68)Ga-PSMA-ligand PET/CT can help delay systemic therapy of PCa.
自采用（68）Ga-PSMA-HBED-CC（=（68）Ga-DKFZ-PSMA-11）进行正电子发射断层扫描（PET）成像以来，该方法被视为复发性前列腺癌（PCa）诊断中的一项重大进展。然而，仅针对小患者队列有已发表的数据。本评估的目的是分析（68）Ga-PSMA配体PET/CT在大型队列中的诊断价值以及几个可能相互作用变量的影响。
我们对2011年至2014年接受（68）Ga-PSMA配体PET/CT检查的319例患者进行了回顾性分析。评估了前列腺特异性抗原（PSA）水平和倍增时间（DT）、 Gleason评分（GSC）、雄激素剥夺治疗（ADT）、年龄和注射示踪剂剂量等几个因素的潜在影响。在（68）Ga-PSMA配体PET/CT检查后，对42例患者进行了组织学验证。在901个代表性肿瘤病灶中测量了示踪剂摄取情况。
在82.8%的患者中检测到至少一个提示PCa的病灶。肿瘤检测与PSA水平和ADT呈正相关。GSC和PSA-DT与肿瘤检测无关。肿瘤病灶的平均最大标准化摄取值（SUVmax）为13.3±14.6（0.7 - 122.5）。在接受组织学检查的病灶中，4例不同患者中有30个为假阴性，所有其他病灶（n = 416）为真阳性或真阴性。基于病灶的敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）分析显示，其值分别为76.6%、100%、91.4%和100%。基于患者的分析显示敏感性为88.1%。在116例可进行随访的患者中，50例在（68）Ga-PSMA配体PET/CT检查后接受了局部治疗。
（68）Ga-PSMA配体PET/CT可在大量患者中检测到复发性PCa。此外，该放射性示踪剂对PCa具有高度特异性。肿瘤检测与PSA和ADT呈正相关。（68）Ga-PSMA配体PET/CT有助于延迟PCa的全身治疗。
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