Department of Radiation Oncology, Saglik Bilimleri University Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey.
Department of Nuclear Medicine, Saglik Bilimleri University Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey.
Ann Nucl Med. 2019 Aug;33(8):545-553. doi: 10.1007/s12149-019-01360-x. Epub 2019 May 8.
The aim of the study was to retrospectively evaluate the recurrence detection rate of Gallium-68-prostate-specific membrane antigen [(Ga)PSMA] imaging and therapy (I&T) positron emission tomography/computed tomography (PET/CT) at different PSA levels, which enables early detection of patients with radical prostatectomy. We also aimed to compare Gleason scores, used drugs (LHRH analogs and antiandrogens), PSA levels with SUV values, and detection rates.
This retrospective study included 107 patients who underwent radical prostatectomy and who underwent (Ga)PSMA I&T PET/CT imaging between January 2015 and December 2018 for the early detection of recurrence. The PSA values, Gleason scores, treatments, lesions detected on (Ga)PSMA I&T, and SUV values were recorded for all patients.
Patients with a median PSA level of 1.22 ng/mL were divided into seven groups according to the PSA values. The lowest lesion detection rate was found to be 7/16 patients (43.8%) when the PSA was < 0.2 ng/ml, and the highest lesion detection rate was found to be 33/33 patients (100%) when the PSA was > 3.5 ng/ml. There was a positive correlation between PSA level and ppSUV (per patient SUV) value of the patients with lesions (p < 0.001 and r = 0.49). As the Gleason score increased, the lesion detection rates also increased and there was a significant correlation between these values (p < 0.001 and r = 0.360). A positive correlation was determined between the Gleason scores and ppSUV values in patients with lesions (p = 0.007 and r = 0.302). A statistically significant correlation was found between bicalutamide use and lesion detection on (Ga)PSMA I&T (p < 0.001). A similar relationship was also determined in patients undergoing maximal androgen blockade (MAB) (p = 0.003). Patients determined with lesions on (Ga)PSMA I&T and who were administered luteinizing hormone-releasing hormone (LHRH) agonists were found to have statistically significantly higher ppSUV values than those who were not administered LHRH agonists (p < 0.001). In binary logistic regression test, when PSA levels and Gleason scores were selected as continuous variables, both PSA levels and Gleason scores were demonstrated as significant covariates (p = 0.006 and p = 0.022) for lesion detection; by contrast, bicalutamide and MAB were not found as significant factors.
In the present study, (Ga)PSMA I&T was found to be quite successful in determining lesions in the biochemical recurrence, which is consistent with the findings of other I&T studies and studies conducted with different PSMA ligands. Thus, it can be considered that the use of (Ga)PSMA I&T will become increasingly common.
本研究旨在回顾性评估前列腺特异性膜抗原[（Ga）PSMA]成像和治疗（I&T）正电子发射断层扫描/计算机断层扫描（PET/CT）在不同 PSA 水平下的复发检测率，从而实现对接受根治性前列腺切除术患者的早期检测。我们还旨在比较 PSA 水平、使用的药物（促黄体激素释放激素类似物和抗雄激素）、SUV 值和检测率与 Gleason 评分、检测到的病变。
本回顾性研究纳入了 107 例患者，这些患者在 2015 年 1 月至 2018 年 12 月期间接受了根治性前列腺切除术，并接受了（Ga）PSMA I&T PET/CT 成像，以早期发现复发。记录了所有患者的 PSA 值、Gleason 评分、治疗、（Ga）PSMA I&T 检测到的病变和 SUV 值。
根据 PSA 值，将中位 PSA 水平为 1.22ng/mL 的患者分为 7 组。当 PSA<0.2ng/ml 时，发现最低病变检测率为 16 例患者中的 7 例（43.8%），当 PSA>3.5ng/ml 时，发现最高病变检测率为 33 例患者中的 33 例（100%）。有病变的患者 PSA 水平与患者每公斤体重的 SUV 值（per patient SUV）呈正相关（p<0.001，r=0.49）。随着 Gleason 评分的增加，病变的检测率也增加，并且这些值之间存在显著相关性（p<0.001，r=0.360）。在有病变的患者中，Gleason 评分与患者每公斤体重的 SUV 值之间也存在正相关（p=0.007，r=0.302）。在接受比卡鲁胺治疗的患者中，（Ga）PSMA I&T 检测到病变与病变检测之间存在显著相关性（p<0.001）。在接受最大雄激素阻断（MAB）治疗的患者中也发现了类似的关系（p=0.003）。在接受（Ga）PSMA I&T 检测到病变并接受促黄体激素释放激素（LHRH）激动剂治疗的患者中，患者每公斤体重的 SUV 值明显高于未接受 LHRH 激动剂治疗的患者（p<0.001）。在二元逻辑回归检验中，当 PSA 水平和 Gleason 评分被选为连续变量时，PSA 水平和 Gleason 评分均被证明是病变检测的显著协变量（p=0.006 和 p=0.022）；相比之下，比卡鲁胺和 MAB 并不是显著因素。
本研究发现（Ga）PSMA I&T 在确定生化复发中的病变方面非常成功，这与其他 I&T 研究和使用不同 PSMA 配体的研究结果一致。因此，可以认为（Ga）PSMA I&T 的使用将变得越来越普遍。
