Department of Oncology, Western University and Lawson Health Research Institute, London, Canada; Department of Medical Biophysics, Western University and Lawson Health Research Institute, London, Canada.
Department of Medical Biophysics, Western University and Lawson Health Research Institute, London, Canada.
Eur Urol Focus. 2018 Sep;4(5):702-706. doi: 10.1016/j.euf.2016.10.002. Epub 2016 Oct 26.
An ongoing prospective study is acquiring preoperative imaging data for men with prostate cancer (PCa) using the molecular imaging agent [F]-DCFPyL targeted against prostate-specific membrane antigen (PSMA). To date, six men (of a planned accrual of 24) with clinically localized, biopsy-proven PCa have undergone preoperative [F]-DCFPyL positron emission tomography (PET) imaging and multiparametric magnetic resonance imaging acquired using a hybrid PET/MRI system. Lesions identified by [F]-DCFPyL uptake on PET/MRI were characterized in terms of maximum standardized uptake value (SUV) and volume using a boundary threshold of 40% SUV. Following surgery, all prostatectomy specimens were processed using a whole-mount technique for accurate deformable co-registration and correlation with PCa foci defined on digitized pathology images. Well-defined intraprostatic dominant lesions were identified by [F]-DCFPyL PET/MRI (mean SUV 11.4±8.25; mean volume 2.2±2.4cm) in all six men. Co-registered digitized whole-mount pathology for the first case revealed that intense [F]-DCFPyL uptake (SUV 27±1.1cm) and multiparametric MRI changes (Prostate Imaging Reporting and Data System score of 4) were highly correlated with a 0.5-cm dominant (largest) lesion with Gleason pattern 4 PCa in the right mid peripheral zone. A smaller focus (0.01cm) of lower-grade PCa (Gleason pattern 3) had much lower uptake (SUV 2.7). These early prospective data show that dominant intraprostatic lesions could be identified in all six men using [F]-DCFPyL as an imaging probe. Trial accrual will continue to quantify in terms of spatial concordance the ability of [F]-DCFPyL to identify the location and characterize the grade of intraprostatic cancer foci in clinically localized PCa. PATIENT SUMMARY: Positron emission tomography using a novel probe called [F]-DCFPyL directed against the prostate-specific membrane antigen protein was able to identify locations of prostate cancer in the prostate glands of men undergoing imaging before surgery. In the future, such imaging may allow better targeting of treatment to the portion of the prostate containing the most aggressive components of cancer rather than treating the whole prostate in a uniform fashion.
一项正在进行的前瞻性研究正在为患有前列腺癌 (PCa) 的男性采集术前成像数据，使用针对前列腺特异性膜抗原 (PSMA) 的分子成像剂 [F]-DCFPyL。迄今为止，已有 6 名（计划入组 24 名）临床局限性、经活检证实的 PCa 男性接受了术前 [F]-DCFPyL 正电子发射断层扫描 (PET) 成像和使用混合 PET/MRI 系统采集的多参数磁共振成像。使用 40% SUV 的边界阈值，根据 [F]-DCFPyL 摄取情况对 PET/MRI 上识别的病变进行最大标准化摄取值 (SUV) 和体积的特征描述。手术后，所有前列腺切除术标本均采用整体技术进行处理，以实现准确的可变形配准，并与数字化病理图像上定义的 PCa 焦点相关联。在所有 6 名男性中，[F]-DCFPyL PET/MRI 均能明确识别前列腺内的明确优势病变（平均 SUV 为 11.4±8.25；平均体积为 2.2±2.4cm）。首例病例的配准数字化整体病理学显示，强烈的 [F]-DCFPyL 摄取（SUV 为 27±1.1cm）和多参数 MRI 改变（前列腺成像报告和数据系统评分 4）与右中叶外周区 0.5cm 的优势（最大）病变高度相关，该病变为 Gleason 模式 4 PCa。较小的（0.01cm）低级别 PCa（Gleason 模式 3）摄取率较低（SUV 为 2.7）。这些早期的前瞻性数据表明，使用 [F]-DCFPyL 作为成像探针，所有 6 名男性均能识别前列腺内的优势病变。试验入组将继续量化 [F]-DCFPyL 识别临床局限性 PCa 前列腺内癌灶位置和特征的能力的空间一致性。患者总结：使用一种新型探针 [F]-DCFPyL 进行正电子发射断层扫描，该探针针对前列腺特异性膜抗原蛋白，能够在手术前对接受成像的男性的前列腺中识别前列腺癌的位置。将来，这种成像技术可能能够更好地针对前列腺中含有最具侵袭性成分的癌灶进行靶向治疗，而不是以统一的方式治疗整个前列腺。
