PSMA 基 F-DCFBC PET/CT 成像在原发局部治疗后生化复发前列腺癌患者中的临床影响。
Clinical impact of PSMA-based F-DCFBC PET/CT imaging in patients with biochemically recurrent prostate cancer after primary local therapy.
机构信息
Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA.
Division of Cancer treatment and Diagnosis: Biometric Research Program, National Cancer Institute, NIH, Bethesda, MD, USA.
出版信息
Eur J Nucl Med Mol Imaging. 2018 Jan;45(1):4-11. doi: 10.1007/s00259-017-3818-x. Epub 2017 Sep 11.
PURPOSE
The purpose of our study was to assess F-DCFBC PET/CT, a PSMA targeted PET agent, for lesion detection and clinical management of biochemical relapse in prostate cancer patients after primary treatment.
METHODS
This is a prospective IRB-approved study of 68 patients with documented biochemical recurrence after primary local therapy consisting of radical prostatectomy (n = 50), post radiation therapy (n = 9) or both (n = 9), with negative conventional imaging. All 68 patients underwent whole-body F-DCFBC PET/CT, and 62 also underwent mpMRI within one month. Lesion detection with F-DCFBC was correlated with mpMRI findings and pre-scan PSA levels. The impact of F-DCFBC PET/CT on clinical management and treatment decisions was established after 6 months' patient clinical follow-up.
RESULTS
Forty-one patients (60.3%) showed at least one positive F-DCFBC lesion, for a total of 79 lesions, 30 in the prostate bed, 39 in lymph nodes, and ten in distant sites. Tumor recurrence was confirmed by either biopsy (13/41 pts), serial CT/MRI (8/41) or clinical follow-up (15/41); there was no confirmation in five patients, who continue to be observed. The F-DCFBC and mpMRI findings were concordant in 39 lesions (49.4%), and discordant in 40 lesions (50.6%); the majority (n = 32/40) of the latter occurring because the recurrence was located outside the mpMRI field of view. F-DCFBC PET positivity rates correlated with PSA values and 15%, 46%, 83%, and 77% were seen in patients with PSA values <0.5, 0.5 to <1.0, 1.0 to <2.0, and ≥2.0 ng/mL, respectively. The optimal cut-off PSA value to predict a positive F-DCFBC scan was 0.78 ng/mL (AUC = 0.764). A change in clinical management occurred in 51.2% (21/41) of patients with a positive F-DCFBC result, generally characterized by starting a new treatment in 19 patients or changing the treatment plan in two patients.
CONCLUSIONS
F-DCFBC detects recurrences in 60.3% of a population of patients with biochemical recurrence, but results are dependent on PSA levels. Above a threshold PSA value of 0.78 ng/mL, F-DCFBC was able to identify recurrence with high reliability. Positive F-DCFBC PET imaging led clinicians to change treatment strategy in 51.2% of patients.
目的
我们研究的目的是评估 F-DCFBC PET/CT，一种针对 PSMA 的 PET 示踪剂，用于检测前列腺癌患者在初次治疗后的生化复发后的病变，并进行临床管理。
方法
这是一项前瞻性 IRB 批准的研究，共纳入 68 例经初次局部治疗（根治性前列腺切除术 n=50 例，放射治疗后 n=9 例，或两者均有 n=9 例）后发生生化复发且常规影像学检查阴性的患者。所有 68 例患者均行全身 F-DCFBC PET/CT 检查，62 例患者在一个月内还进行了 mpMRI 检查。F-DCFBC 检测到的病变与 mpMRI 结果和术前 PSA 水平相关。在对患者进行 6 个月的临床随访后，确定 F-DCFBC PET/CT 对临床管理和治疗决策的影响。
结果
41 例患者（60.3%）至少有 1 个 F-DCFBC 阳性病灶，共 79 个病灶，其中 30 个位于前列腺床，39 个位于淋巴结，10 个位于远处。肿瘤复发通过活检（13/41 例）、连续 CT/MRI（8/41 例）或临床随访（15/41 例）证实；有 5 例患者未得到证实，他们仍在观察中。F-DCFBC 和 mpMRI 的结果在 39 个病灶（49.4%）中是一致的，在 40 个病灶（50.6%）中是不一致的；后者中大多数（n=32/40）的病灶位于 mpMRI 视野之外。F-DCFBC PET 阳性率与 PSA 值相关，在 PSA 值<0.5、0.5-<1.0、1.0-<2.0 和≥2.0ng/mL 的患者中分别为 15%、46%、83%和 77%。预测 F-DCFBC 扫描阳性的最佳 PSA 值截断点为 0.78ng/mL（AUC=0.764）。41 例阳性 F-DCFBC 结果的患者中有 51.2%（21/41）的临床管理发生了改变，通常表现为 19 例患者开始新的治疗，2 例患者改变治疗方案。
结论
F-DCFBC 在生化复发患者人群中检测到 60.3%的复发，但结果取决于 PSA 水平。在 PSA 值超过 0.78ng/mL 的阈值后，F-DCFBC 能够可靠地识别复发。阳性 F-DCFBC PET 成像导致 51.2%的患者改变了治疗策略。
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