Medina-Ornelas Sevastián S, García-Pérez Francisco O, Hernández-Pedro Norma Y, Arellano-Zarate Angélica E, Abúndiz-López Blanca L
Departamento de Medicina Nuclear e Imagen Molecular, Instituto Nacional de Cancerología, Ciudad de México, México.
Departamento de Medicina Nuclear e Imagen Molecular, Instituto Nacional de Cancerología, Ciudad de México, México.
Rev Esp Med Nucl Imagen Mol (Engl Ed). 2018 Jul-Aug;37(4):223-228. doi: 10.1016/j.remn.2017.10.005. Epub 2018 Feb 14.
To investigate the association between prostatic-specific antigen (PSA) levels and molecular tumor volume (MTV) measured in the Ga-PSMA PET/CT, both done in a short period of time, in prostate cancer patients with biochemical failure.
Eighty-four patients who underwent Ga-PSMA PET/CT and measurement of PSA levels in the same week (trigger-PSA) were studied in this retrospective analysis. MTV was calculated from the sum of the metastatic lesions. To determine the association between trigger-PSA level and PET/CT findings, Spearman rank correlation was used.
The median MTV of metastatic bone disease (mBD) was significantly higher than in metastatic lymph-nodes (mLN) (139.5 versus 17.7; P<.05). Disease was limited to the prostate in 8 patients (9.5%), mLN in 21 patients (25%), mBD in 32 patients (38.1%) and the 3 sites (prostate, mLN, and mBD) in 17 patients (20.2%). In 6 patients (6.14%), Ga-PSMA-PET/CT was not capable of detecting disease. The median trigger-PSA levels of patients with disease limited to the prostate (2.8ng/mL), mLN (6.8ng/mL), and for mBD (16.8ng/mL) was statically significant (P<.05). Positive patients had a mean trigger-PSA of 4.3ng/mL vs 1.5ng/mL in negative patients (P<.05). We established 3 threshold-points for trigger-PSA level detection rate:≤1ng/mL (47.3%), 1-4ng/mL (68.4%) and≥4ng/mL (96.7%). When trigger-PSA exceeded 4ng/mL, the MTV was higher (P<.001).
The correlation of MTV with trigger-PSA is demonstrated, which may have an impact on management. However, trigger-PSA levels were not capable of distinguishing between localized or distant disease. An accurate detection of disease can lead to a better therapeutic strategy.
在短期内均进行了镓-前列腺特异性膜抗原（Ga-PSMA）PET/CT检查及前列腺特异性抗原（PSA）水平检测的生化复发前列腺癌患者中，研究PSA水平与Ga-PSMA PET/CT测得的分子肿瘤体积（MTV）之间的关联。
在这项回顾性分析中，研究了84例在同一周内接受Ga-PSMA PET/CT检查及PSA水平检测（触发PSA）的患者。MTV由转移灶的总和计算得出。为确定触发PSA水平与PET/CT检查结果之间的关联，采用Spearman等级相关性分析。
转移性骨病（mBD）的MTV中位数显著高于转移性淋巴结（mLN）（139.5对17.7；P<0.05）。8例患者（9.5%）疾病局限于前列腺，21例患者（25%）有mLN转移，32例患者（38.1%）有mBD转移，17例患者（20.2%）在3个部位（前列腺、mLN和mBD）均有转移。6例患者（6.14%）Ga-PSMA-PET/CT未能检测到疾病。疾病局限于前列腺、mLN和mBD的患者触发PSA水平中位数分别为（2.8ng/mL）、（6.8ng/mL）和（16.8ng/mL），差异有统计学意义（P<0.05）。阳性患者的平均触发PSA为4.3ng/mL，阴性患者为1.5ng/mL（P<0.05）。我们确定了触发PSA水平检测率的3个阈值点：≤1ng/mL（47.3%）、1 - 4ng/mL（68.4%）和≥4ng/mL（96.7%）。当触发PSA超过4ng/mL时，MTV更高（P<0.001）。
证实了MTV与触发PSA之间的相关性，这可能对治疗管理有影响。然而，触发PSA水平无法区分局限性或远处疾病。准确检测疾病可带来更好的治疗策略。
