Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany.
J Nucl Med. 2016 Apr;57(4):563-7. doi: 10.2967/jnumed.115.169243. Epub 2016 Jan 14.
We evaluated the diagnostic value and accuracy of prostate-specific membrane antigen (PSMA) PET for the intraprostatic delineation of prostate cancer before prostatectomy.
We identified 6 patients with biopsy-proven high-risk prostate cancer who were referred for (68)Ga-PSMA PET/CT before radical prostatectomy to rule out metastasis. After prostatectomy, a histologic map of the prostate was reconstructed. The histologic extent and Gleason score of each segment of the prostate were compared with (68)Ga-PSMA PET images resliced to the histologic axis. Sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios were calculated. The SUV of each segment was measured, and median values were compared.
Of the 132 segments, 112 were eligible for analysis. The correlation of histologic results with (68)Ga-PSMA PET images showed a specificity and sensitivity of 92%. The positive and negative likelihood ratio and the positive and negative predictive value for detection of prostate cancer on (68)Ga-PSMA PET were 11.5, 0.09, 96%, and 85%, respectively. The median SUVmax of true-positive prostate segments was significantly higher than that of true-negative segments (11.0 ± 7.8 vs. 2.7 ± 0.9, P< 0.001), and a cutoff of 4 revealed a sensitivity and specificity of 86.5% and an accuracy of 87.5%.
These preliminary results show that the intraprostatic localization and extent of prostate cancer may be estimated by (68)Ga-PSMA PET. This imaging method may be helpful for identifying target lesions before prostate biopsy and may support decision making before focal or radical therapy.
我们评估了前列腺特异性膜抗原（PSMA）PET 在前列腺癌术前前列腺内描绘中的诊断价值和准确性。
我们确定了 6 例经活检证实患有高危前列腺癌并在根治性前列腺切除术前接受（68）Ga-PSMA PET/CT 以排除转移的患者。前列腺切除术后，重建前列腺的组织学图谱。将前列腺各节段的组织学范围和 Gleason 评分与按组织学轴重切的（68）Ga-PSMA PET 图像进行比较。计算敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比。测量每个节段的 SUV，并比较中位数。
在 132 个节段中，有 112 个节段符合分析条件。组织学结果与（68）Ga-PSMA PET 图像的相关性显示出 92%的特异性和敏感性。（68）Ga-PSMA PET 检测前列腺癌的阳性和阴性似然比以及阳性和阴性预测值分别为 11.5、0.09、96%和 85%。真阳性前列腺节段的 SUVmax 中位数明显高于真阴性节段（11.0±7.8 比 2.7±0.9，P<0.001），而截断值为 4 时，敏感性和特异性分别为 86.5%和 87.5%，准确性为 87.5%。
这些初步结果表明，（68）Ga-PSMA PET 可估计前列腺癌的前列腺内定位和范围。这种成像方法可能有助于在前列腺活检前识别靶病变，并可能支持在局部或根治性治疗前的决策。
