镓-68前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描对前列腺癌的临床应用价值

Clinical Utility of Gallium-68 PSMA PET/CT Scan for Prostate Cancer.

作者信息

Kallur Kumaraswamy G, Ramachandra Prashanth G, Rajkumar Krishnappa, Swamy Shivakumar S, Desai Indiresh, Rao Raghavendra M, Patil Shekhar Gowda, Sridhar P S, Madhusudhan Nagaraj, Krishnappa Raghunath S, Bhadrasetty Veerendra, Kumara Hemantha M, Santhosh S D, Ajaikumar Basavalingaiah S

机构信息

Dept of Molecular Imaging, HCG Foundation, Bengaluru, India.

Center for Academics and Research, HCG Foundation, Bengaluru, India.

出版信息

Indian J Nucl Med. 2017 Apr-Jun;32(2):110-117. doi: 10.4103/0972-3919.202255.

BACKGROUND

Prostate cancer is biologically and clinically a heterogeneous disease that makes imaging evaluation challenging. One of the important challenges in this cancer is to detect recurrent disease. Biochemical response using Prostate Specific Antigen (PSA) and Imaging using several PET tracers have poor sensitivity and specificity. Therefore, we analyse the role of Ga68-PSMA (Prostate Specific Membrane Antigen) imaging in prostate cancer, which is a new PET tracer.

METHODS

In this study, we evaluated PET scans of 262 patients with diagnosis of prostate cancer. These patients were scanned using Ga68-PSMA for either staging or response evaluation.

RESULTS

336 PSMA scans were performed. Ga68-PSMA scan resulted in the detection of extra-prostatic disease in 53.2% of cases when done at baseline before commencing any treatment. The sensitivity of Ga68-PSMA at baseline with histopathological diagnosis was 95% with 95% CI ranging from 86% to 98%. The positive predictive value was high at 98% with 95% CI ranging from 91% to 99%. In 26 (10%) patients who had surgical castration, Ga68-PSMA scan was able to detect disease progression / castration resistance in 100% of cases. The outcome of castration-resistant prostate cancer was compared with other cases where castration was not done. In those who did not undergo castration, there was a significantly better response by hormone therapy (p = 0.03) and radiotherapy (p = 0.01) on Ga68-PSMA. The sensitivity of Ga68-PSMA response with biochemical response was 66.7% with 95% CI ranging between 46 %- 82.7%. Ga68-PSMA response did not correlate with biochemical response.

CONCLUSION

Ga68-PSMA has good sensitivity for diagnosis, staging, restaging, evaluation of therapy response and prognostication in prostate cancer.

背景

前列腺癌在生物学和临床上是一种异质性疾病，这使得影像学评估具有挑战性。该癌症的一个重要挑战是检测复发性疾病。使用前列腺特异性抗原（PSA）进行生化反应以及使用几种PET示踪剂进行成像的敏感性和特异性都很差。因此，我们分析了新型PET示踪剂Ga68-PSMA（前列腺特异性膜抗原）成像在前列腺癌中的作用。

方法

在本研究中，我们评估了262例前列腺癌诊断患者的PET扫描。这些患者使用Ga68-PSMA进行扫描，以进行分期或反应评估。

结果

共进行了336次PSMA扫描。在开始任何治疗前的基线期进行Ga68-PSMA扫描时，53.2%的病例检测到前列腺外疾病。Ga68-PSMA在基线期与组织病理学诊断的敏感性为95%，95%置信区间为86%至98%。阳性预测值很高，为98%，95%置信区间为91%至99%。在26例（10%）接受手术去势的患者中，Ga68-PSMA扫描能够在100%的病例中检测到疾病进展/去势抵抗。将去势抵抗性前列腺癌的结果与未进行去势的其他病例进行了比较。在未接受去势的患者中，激素治疗（p = 0.03）和放疗（p = 0.01）对Ga68-PSMA的反应明显更好。Ga68-PSMA反应与生化反应的敏感性为66.7%，95%置信区间在46%-82.7%之间。Ga68-PSMA反应与生化反应不相关。