Wesley Urology Clinic, Brisbane, Queensland, Australia.
Department of Medicine, University of Queensland, Brisbane, Queensland, Australia.
BJU Int. 2019 Sep;124(3):401-407. doi: 10.1111/bju.14828. Epub 2019 Jul 2.
OBJECTIVE: To determine the number of men with gallium-prostate-specific membrane antigen positron emission tomography/computed tomography ( Ga-PSMA PET/CT) avid metastasis at diagnosis, as most data on Ga-PSMA PET/CT are for the evaluation of recurrent disease after primary treatment and to our knowledge this study is the largest series of primary prostate cancer staging with Ga-PSMA PET/CT. PATIENTS AND METHODS: A retrospective review conducted on 1253 consecutive men referred by urologists or radiation oncologists to our tertiary referral centre for Ga-PSMA PET/CT scan for staging at the initial diagnosis of prostate cancer between July 2014 and June 2018. The primary outcome measure was to determine the risk of metastasis based on Ga-PSMA PET/CT. Patients were risk stratified based on histological biopsy International Society of Urological Pathology (ISUP) grade, prostate-specific antigen (PSA) level, and staging with pre-biopsy multiparametric magnetic resonance imaging (mpMRI). Univariate and multivariate logistic regression were used to analyse results. RESULTS: The median PSA level was 6.5 ng/mL and median ISUP grade was 3, with high-risk disease in 49.7%. The prostate primary was PSMA avid in 91.7% of men. Metastatic disease was identified in 12.1% of men, including 8.2% with a PSA level of <10 ng/mL and 43% with a PSA level of >20 ng/mL. Metastases were identified in 6.4% with ISUP grade 2-3 and 21% with ISUP grade 4-5. Pre-biopsy mpMRI identified metastasis in 8.1% of T2 disease, increasing to 42.4% of T3b. Lymph node metastases were suspected in 107 men, with 47.7% outside the boundaries of an extended pelvic lymph node dissection. Skeletal metastases were identified in 4.7%. In men with intermediate-risk prostate cancer, metastases were identified in 5.2%, compared to 19.9% with high-risk disease. CONCLUSIONS: These results support the use of Ga-PSMA PET/CT for primary staging of prostate cancer. Increasing PSA level, ISUP grade and radiological staging with mpMRI were all statistically significant prognostic factors for metastasis on both univariate and multivariate analysis.
目的：确定在诊断时存在镓-前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描（Ga-PSMA PET/CT）阳性转移的男性人数，因为大多数 Ga-PSMA PET/CT 数据都用于评估初次治疗后的复发疾病，据我们所知，这项研究是最大的一组使用 Ga-PSMA PET/CT 进行的原发性前列腺癌分期系列。
患者和方法：回顾性分析了 2014 年 7 月至 2018 年 6 月期间，1253 例连续就诊的男性患者，这些患者因初次诊断前列腺癌而由泌尿科医生或放射肿瘤学家转介至我们的三级转诊中心进行 Ga-PSMA PET/CT 扫描进行分期。主要观察指标是根据 Ga-PSMA PET/CT 确定转移风险。患者根据组织学活检国际泌尿病理学会（ISUP）分级、前列腺特异性抗原（PSA）水平和活检前多参数磁共振成像（mpMRI）进行风险分层。采用单因素和多因素逻辑回归分析结果。
结果：中位 PSA 水平为 6.5ng/mL，中位 ISUP 分级为 3 级，高危疾病占 49.7%。91.7%的男性前列腺原发灶 PSMA 阳性。12.1%的男性发现转移性疾病，包括 8.2%的 PSA 水平<10ng/mL 和 43%的 PSA 水平>20ng/mL。6.4%的 ISUP 分级为 2-3 级和 21%的 ISUP 分级为 4-5 级患者中发现了转移。在 T2 疾病中，活检前 mpMRI 发现转移的比例为 8.1%，在 T3b 疾病中增加到 42.4%。107 例男性怀疑有淋巴结转移，其中 47.7%位于扩大盆腔淋巴结清扫术的边界之外。4.7%的患者发现有骨骼转移。在中危前列腺癌患者中，转移发生率为 5.2%，高危疾病的转移发生率为 19.9%。
结论：这些结果支持使用 Ga-PSMA PET/CT 进行前列腺癌的初始分期。PSA 水平、ISUP 分级和 mpMRI 影像学分期的升高均是单因素和多因素分析中具有统计学意义的转移预后因素。
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