Ceci Francesco, Uprimny Christian, Nilica Bernhard, Geraldo Llanos, Kendler Dorota, Kroiss Alexander, Bektic Jasmin, Horninger Wolfgang, Lukas Peter, Decristoforo Clemens, Castellucci Paolo, Fanti Stefano, Virgolini Irene J
Department of Nuclear Medicine, Medizinische Universität Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria,
Eur J Nucl Med Mol Imaging. 2015 Jul;42(8):1284-94. doi: 10.1007/s00259-015-3078-6. Epub 2015 May 15.
To assess the association between PSA levels, PSA kinetics and other factors and a pathological (68)Ga-PSMA PET/CT scan in patients with recurrent prostate cancer (rPCa) with biochemical relapse (BR) after radical therapy.
Seventy consecutive rPCA patients referred for (68)Ga-PSMA PET/CT, matching all the following criteria, were retrospectively evaluated: (a) previous radical prostatectomy or primary radiotherapy with curative intent; (b) BR or persisting high PSA levels after primary treatment; and (c) complete clinical and imaging information. The mean ± SD PSA level was 3.5 ± 5.3 ng/mL (median 1.7, range 0.2 - 32.2 ng/mL), the mean ± SD PSA doubling time (PSAdt) was 6.5 ± 5.5 months (median 5.5, range 1.3 - 31.6 months), and the mean ± SD PSA velocity was 7.9 ± 20.5 (median 2.1, range 0.2 - 147.5 ng/mL/year). Statistical analysis was performed to assess which factors were associated with the detection of rPCa on (68)Ga-PSMA PET/CT.
(68)Ga-PSMA PET/CT was positive in 52 of 70 patients (74.2%). In 30 patients (42.8%) lesions limited to the pelvis were detected. Distant lesions were observed in 8 of patients (11.4%). Local plus systemic lesions were detected in 14 patients (20%). PSA level (p = 0.017) and PSAdt (p = 0.0001) were significantly different between PET-positive patients (higher PSA level, shorter PSAdt) and PET-negative patients (lower PSA, longer PSAdt). ROC analysis showed that PSAdt 6.5 months and PSA 0.83 ng/mL were optimal cut-off values. In multivariate analysis PSAdt was associated with (68)Ga-PSMA PET/CT positivity. (68)Ga-PSMA PET/CT was positive in 17 of 20 patients (85%) with PSA <2 ng/mL and PSAdt <6.5 months, and in 3 of 16 patients (18.7%) with PSA <2 ng/mL and PSAdt ≥6.5 months.
The great potential of (68)Ga-PSMA PET/CT in patients with rPCa and BR was confirmed. PSA and PSAdt were valuable predictors of pathological (68)Ga-PSMA PET/CT findings.
评估前列腺癌根治术后生化复发（BR）的复发性前列腺癌（rPCa）患者的前列腺特异性抗原（PSA）水平、PSA动力学及其他因素与病理（68）镓-前列腺特异性膜抗原（PSMA）PET/CT扫描之间的关联。
回顾性评估连续70例因（68）Ga-PSMA PET/CT检查就诊的rPCA患者，所有患者均符合以下标准：（a）既往行根治性前列腺切除术或根治性意图的原发性放疗；（b）原发性治疗后出现BR或PSA持续高水平；（c）具备完整的临床和影像学资料。PSA水平的均值±标准差为3.5±5.3 ng/mL（中位数1.7，范围0.2 - 32.2 ng/mL），PSA倍增时间（PSAdt）的均值±标准差为6.5±5.5个月（中位数5.5，范围1.3 - 31.6个月），PSA速度的均值±标准差为7.9±20.5（中位数2.1，范围0.2 - 147.5 ng/mL/年）。进行统计分析以评估哪些因素与（68）Ga-PSMA PET/CT上rPCa的检测相关。
70例患者中有52例（74.2%）（68）Ga-PSMA PET/CT呈阳性。30例患者（42.8%）检测到局限于盆腔的病变。8例患者（11.4%）观察到远处病变。14例患者（20%）检测到局部加全身病变。PET阳性患者（PSA水平较高，PSAdt较短）和PET阴性患者（PSA较低，PSAdt较长）之间的PSA水平（p = 0.017）和PSAdt（p = 0.0001）有显著差异。ROC分析显示PSAdt 6.5个月和PSA 0.83 ng/mL为最佳临界值。多因素分析显示PSAdt与（68）Ga-PSMA PET/CT阳性相关。20例PSA<2 ng/mL且PSAdt<6.5个月的患者中有17例（85%）（68）Ga-PSMA PET/CT呈阳性，16例PSA<2 ng/mL且PSAdt≥6.5个月的患者中有3例（18.7%）呈阳性。
证实了（68）Ga-PSMA PET/CT在rPCa和BR患者中的巨大潜力。PSA和PSAdt是病理（68）Ga-PSMA PET/CT检查结果的有价值预测指标。
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