Turkbey Baris, Mena Esther, Lindenberg Liza, Adler Stephen, Bednarova Sandra, Berman Rose, Ton Anita T, McKinney Yolanda, Eclarinal Philip, Hill Craig, Afari George, Bhattacharyya Sibaprasad, Mease Ronnie C, Merino Maria J, Jacobs Paula M, Wood Bradford J, Pinto Peter A, Pomper Martin G, Choyke Peter L
From the *Molecular Imaging Program, National Cancer Institute, Bethesda; †Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc, Frederick, MD; ‡Institute of Diagnostic Radiology, Department of Medical Area, University of Udine, Udine, Italy; §Office of the Clinical Director/Center for Cancer Research/National Cancer Institute, Bethesda; ∥Applied/Developmental Research Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick; ¶Office of the Pharmaceutical Quality, FDA/CDER, Silver Spring; **Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore; ††Laboratory of Pathology, National Cancer Institute, Bethesda; ‡‡Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville; §§Center for Interventional Oncology, National Cancer Institute and Clinical Center, and Radiology Imaging Sciences, National Institutes of Health, Bethesda; and ∥∥Urologic Oncology Branch, National Cancer Institute, Bethesda, MD.
Clin Nucl Med. 2017 Oct;42(10):735-740. doi: 10.1097/RLU.0000000000001804.
To assess the ability of (N-[N-[(S)-1,3-dicarboxypropyl]carbamoyl]-4-F-fluorobenzyl-L-cysteine) (F-DCFBC), a prostate-specific membrane antigen-targeted PET agent, to detect localized prostate cancer lesions in correlation with multiparametric MRI (mpMRI) and histopathology.
This Health Insurance Portability and Accountability Act of 1996-compliant, prospective, institutional review board-approved study included 13 evaluable patients with localized prostate cancer (median age, 62.8 years [range, 51-74 years]; median prostate-specific antigen, 37.5 ng/dL [range, 3.26-216 ng/dL]). Patients underwent mpMRI and F-DCFBC PET/CT within a 3 months' window. Lesions seen on mpMRI were biopsied under transrectal ultrasound/MRI fusion-guided biopsy, or a radical prostatectomy was performed. F-DCFBC PET/CT and mpMRI were evaluated blinded and separately for tumor detection on a lesion basis. For PET image analysis, MRI and F-DCFBC PET images were fused by using software registration; imaging findings were correlated with histology, and uptake of F-DCFBC in tumors was compared with uptake in benign prostatic hyperplasia nodules and normal peripheral zone tissue using the 80% threshold SUVmax.
A total of 25 tumor foci (mean size, 1.8 cm; median size, 1.5 cm; range, 0.6-4.7 cm) were histopathologically identified in 13 patients. Sensitivity rates of F-DCFBC PET/CT and mpMRI were 36% and 96%, respectively, for all tumors. For index lesions, the largest tumor with highest Gleason score, sensitivity rates of F-DCFBC PET/CT and mpMRI were 61.5% and 92%, respectively. The average SUVmax for primary prostate cancer was higher (5.8 ± 4.4) than that of benign prostatic hyperplasia nodules (2.1 ± 0.3) or that of normal prostate tissue (2.1 ± 0.4) at 1 hour postinjection (P = 0.0033).
The majority of index prostate cancers are detected with F-DCFBC PET/CT, and this may be a prognostic indicator based on uptake and staging. However, for detecting prostate cancer with high sensitivity, it is important to combine prostate-specific membrane antigen PET/CT with mpMRI.
评估前列腺特异性膜抗原靶向正电子发射断层显像剂（N-[N-[(S)-1,3-二羧基丙基]氨基甲酰基]-4-F-氟苄基-L-半胱氨酸）（F-DCFBC）与多参数磁共振成像（mpMRI）及组织病理学相关联检测局限性前列腺癌病灶的能力。
这项符合1996年《健康保险流通与责任法案》、前瞻性、经机构审查委员会批准的研究纳入了13例可评估的局限性前列腺癌患者（中位年龄62.8岁[范围51 - 74岁]；中位前列腺特异性抗原37.5 ng/dL[范围3.26 - 216 ng/dL]）。患者在3个月内接受了mpMRI和F-DCFBC正电子发射断层显像/计算机断层扫描（PET/CT）。mpMRI上发现的病灶在经直肠超声/MRI融合引导下进行活检，或进行根治性前列腺切除术。对F-DCFBC PET/CT和mpMRI进行盲法评估，并分别以病灶为基础检测肿瘤。对于PET图像分析，通过软件配准融合MRI和F-DCFBC PET图像；将影像学表现与组织学相关联，并使用80%的SUVmax阈值将肿瘤中F-DCFBC的摄取与良性前列腺增生结节及正常外周带组织中的摄取进行比较。
13例患者经组织病理学共鉴定出25个肿瘤病灶（平均大小1.8 cm；中位大小1.5 cm；范围0.6 - 4.7 cm）。F-DCFBC PET/CT和mpMRI对所有肿瘤的灵敏度分别为36%和96%。对于索引病灶，即Gleason评分最高的最大肿瘤，F-DCFBC PET/CT和mpMRI的灵敏度分别为61.5%和92%。注射后1小时，原发性前列腺癌的平均SUVmax（5.8±4.4）高于良性前列腺增生结节（2.1±0.3）或正常前列腺组织（2.1±0.4）（P = 0.0033）。
多数索引前列腺癌可用F-DCFBC PET/CT检测到，基于摄取和分期这可能是一个预后指标。然而，为了高灵敏度地检测前列腺癌，将前列腺特异性膜抗原PET/CT与mpMRI相结合很重要。
