Department of Urology, Technische Universität München, Klinikum rechts der Isar, Ismaninger Strasse 22, 81671 Munich, Germany.
Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Ismaninger Strasse 22, 81671 Munich, Germany.
Nat Rev Urol. 2016 Apr;13(4):226-35. doi: 10.1038/nrurol.2016.26. Epub 2016 Feb 23.
Currently, the findings of imaging procedures used for detection or staging of prostate cancer depend on morphology of lymph nodes or bone metabolism and do not always meet diagnostic needs. Prostate-specific membrane antigen (PSMA), a transmembrane protein that has considerable overexpression on most prostate cancer cells, has gained increasing interest as a target molecule for imaging. To date, several small compounds for labelling PSMA have been developed and are currently being investigated as imaging probes for PET with the (68)Ga-labelled PSMA inhibitor Glu-NH-CO-NH-Lys(Ahx)-HBED-CC being the most widely studied agent. (68)Ga-PSMA-PET imaging in combination with multiparametric MRI (mpMRI) might provide additional molecular information on cancer localization within the prostate. In patients with primary prostate cancer of intermediate-risk to high-risk, PSMA-based imaging has been reported to improve detection of metastatic disease compared with CT or mpMRI, rendering additional cross-sectional imaging or bone scintigraphy unnecessary. Furthermore, in patients with biochemically recurrent prostate cancer, use of (68)Ga-PSMA-PET imaging has been shown to increase detection of metastatic sites, even at low serum PSA values, compared with conventional imaging or PET examination with different tracers. Thus, although current knowledge is still limited and derived mostly from retrospective series, PSMA-based imaging holds great promise to improve prostate cancer management.
目前,用于前列腺癌检测或分期的影像学检查结果取决于淋巴结的形态或骨骼代谢,并不总能满足诊断需求。前列腺特异性膜抗原(PSMA)是一种跨膜蛋白,在大多数前列腺癌细胞上有相当高的过表达,作为成像的靶标分子越来越受到关注。迄今为止,已经开发出几种用于标记 PSMA 的小分子化合物,并作为正电子发射断层扫描(PET)的成像探针进行研究,其中最广泛研究的是(68)Ga 标记的 PSMA 抑制剂 Glu-NH-CO-NH-Lys(Ahx)-HBED-CC。(68)Ga-PSMA-PET 成像与多参数 MRI(mpMRI)结合可能会提供有关前列腺内癌症定位的额外分子信息。在中高危原发性前列腺癌患者中,与 CT 或 mpMRI 相比,基于 PSMA 的成像已被报道可提高转移性疾病的检出率,从而使额外的横断面成像或骨闪烁显像成为不必要。此外,在生化复发的前列腺癌患者中,与使用不同示踪剂的常规成像或 PET 检查相比,(68)Ga-PSMA-PET 成像已被证明可提高转移性病灶的检出率,甚至在血清 PSA 值较低时也是如此。因此,尽管目前的知识仍然有限,并且主要来自回顾性系列研究,但基于 PSMA 的成像有望改善前列腺癌的管理。
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