Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy.
Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
Eur J Nucl Med Mol Imaging. 2018 Nov;45(12):2035-2044. doi: 10.1007/s00259-018-4067-3. Epub 2018 Jun 19.
We studied the usefulness of Ga-prostate-specific membrane antigen (PSMA) PET/CT for detecting relapse in a prospective series of patients with biochemical recurrence (BCR) of prostate cancer (PCa) after radical treatment.
Patients with BCR of PCa after radical surgery and/or radiotherapy with or without androgen-deprivation therapy were included in the study. Ga-PSMA PET/CT scans performed from the top of the head to the mid-thigh 60 min after intravenous injection of 150 ± 50 MBq of Ga-PSMA were interpreted by two nuclear medicine physicians. The results were correlated with prostate-specific antigen (PSA) levels at the time of the scan (PSApet), PSA doubling time, Gleason score, tumour stage, postsurgery tumour residue, time from primary therapy to BCR, and patient age. When available, Ga-PSMA PET/CT scans were compared with negative F-choline PET/CT scans routinely performed up to 1 month previously.
From November 2015 to October 2017, 314 PCa patients with BCR were evaluated. Their median age was 70 years (range 44-92 years) and their median PSApet was 0.83 ng/ml (range 0.003-80.0 ng/ml). Ga-PSMA PET/CT was positive (one or more suspected PCa lesions detected) in 197 patients (62.7%). Lesions limited to the pelvis, i.e. the prostate/prostate bed and/or pelvic lymph nodes (LNs), were detected in 117 patients (59.4%). At least one distant lesion (LNs, bone, other organs, separately or combined with local lesions) was detected in 80 patients (40.6%). PSApet was higher in PET-positive than in PET-negative patients (P < 0.0001). Of 88 patients negative on choline PET/CT scans, 59 (67%) were positive on Ga-PSMA PET/CT.
We confirmed the value of Ga-PSMA PET/CT in restaging PCa patients with BCR, highlighting its superior performance and safety compared with choline PET/CT. Higher PSApet was associated with a higher relapse detection rate.
我们研究了 Ga-前列腺特异性膜抗原（PSMA）PET/CT 在根治性治疗后前列腺癌（PCa）生化复发（BCR）患者前瞻性系列中检测复发的有用性。
本研究纳入了根治性手术和/或放疗后伴或不伴雄激素剥夺治疗的 BCR PCa 患者。在静脉注射 150±50MBq Ga-PSMA 后 60 分钟，从头顶至大腿中部进行 Ga-PSMA PET/CT 扫描。两名核医学医师对扫描结果进行解读。结果与扫描时的前列腺特异性抗原（PSA）水平（PSApet）、PSA 倍增时间、Gleason 评分、肿瘤分期、术后肿瘤残留、从初始治疗到 BCR 的时间以及患者年龄相关。当有条件时，将 Ga-PSMA PET/CT 扫描与常规在 1 个月内进行的阴性 F-胆碱 PET/CT 扫描进行比较。
2015 年 11 月至 2017 年 10 月，对 314 例 BCR PCa 患者进行了评估。他们的中位年龄为 70 岁（范围 44-92 岁），中位 PSApet 为 0.83ng/ml（范围 0.003-80.0ng/ml）。197 例患者（62.7%）的 Ga-PSMA PET/CT 为阳性（检测到一个或多个可疑 PCa 病灶）。117 例患者（59.4%）的病变仅限于骨盆，即前列腺/前列腺床和/或盆腔淋巴结（LN）。80 例患者（40.6%）至少有一个远处病灶（LN、骨骼、其他器官，单独或与局部病灶结合）。PET 阳性患者的 PSApet 高于 PET 阴性患者（P<0.0001）。在阴性胆碱 PET/CT 扫描的 88 例患者中，59 例（67%）在 Ga-PSMA PET/CT 上为阳性。
我们证实了 Ga-PSMA PET/CT 在 BCR PCa 患者分期中的价值，突出了其与胆碱 PET/CT 相比具有更高的性能和安全性。较高的 PSApet 与更高的复发检出率相关。
