Royal Brisbane & Women's Hospital, Brisbane, Australia.
Wesley Urology Clinic, Brisbane, Australia.
Eur J Nucl Med Mol Imaging. 2019 Oct;46(11):2280-2288. doi: 10.1007/s00259-019-04432-2. Epub 2019 Jul 23.
The role of Ga-PSMA PET/CT in the staging of prostate cancer is well known. PSMA is also overexpressed in the neovasculature of other tumours including renal cell carcinoma (RCC), suggesting there may be a role for the use of Ga-PSMA PET/CT. Thus far, there has been limited literature documenting the use of Ga-PSMA PET/CT in the investigation and management decisions of RCC.
This was a retrospective case series of patients who received a Ga-PSMA PET/CT scan for staging or restaging of RCC between July 2016 and December 2018. Primary outcome measure was to identify whether Ga-PSMA PET/CT changed management compared to standard diagnostic CT imaging. Analysis was based on four categories: (1) identification of new disease, (2) refuting disease on CT imaging, (3) identification of synchronous primaries, and (4) concordance with CT imaging.
38 Ga-PSMA PET/CT scans met inclusion criteria. Primary staging scans were performed in 16 patients, of which 75% showed avid primary lesions, with the majority of clear cell subtype. Management was changed in 43.8% of patients. CT agreed with Ga-PSMA PET/CT in 37.5% of cases. Restaging scans were performed in 22 patients. 40.9% of patients had management changed by results of Ga- PSMA PET/CT. CT agreed with Ga- PSMA PET/CT in 36.4% of cases. Management was predominantly changed due to the identification of new sites of suspected metastases, as well as the detection of synchronous primaries.
Ga-PSMA PET/CT directly changed management in 42.1% of cases. Strongest detection rates occurred in those patients with clear cell RCC. The results of this study suggest there may be merit in the use of the modality in the staging of RCC. Further analysis, both with respect to histological confirmation, efficacy and cost-benefit, is required to determine whether there is a role for routine Ga-PSMA PET/CT imaging.
镓-PSMA PET/CT 在前列腺癌分期中的作用众所周知。PSMA 在包括肾细胞癌（RCC）在内的其他肿瘤的新生血管中也过度表达，这表明 Ga-PSMA PET/CT 的使用可能具有一定作用。迄今为止，关于 Ga-PSMA PET/CT 在 RCC 的检查和管理决策中的应用，文献记载有限。
这是一项回顾性病例系列研究，纳入了 2016 年 7 月至 2018 年 12 月期间接受 Ga-PSMA PET/CT 扫描以分期或重新分期 RCC 的患者。主要观察指标是确定与标准诊断 CT 成像相比，Ga-PSMA PET/CT 是否改变了治疗方案。分析基于以下四个类别：（1）是否发现新的疾病；（2）CT 成像是否排除了疾病；（3）是否发现同时存在的原发性肿瘤；（4）是否与 CT 成像一致。
38 例 Ga-PSMA PET/CT 扫描符合纳入标准。16 例患者进行了初始分期扫描，其中 75%显示出活跃的原发性病变，主要为透明细胞亚型。43.8%的患者治疗方案发生了改变。CT 与 Ga-PSMA PET/CT 结果一致的占 37.5%。22 例患者进行了重新分期扫描。40.9%的患者通过 Ga-PSMA PET/CT 结果改变了治疗方案。CT 与 Ga-PSMA PET/CT 结果一致的占 36.4%。治疗方案的改变主要是因为发现了疑似转移的新部位，以及检测到同时存在的原发性肿瘤。
Ga-PSMA PET/CT 直接改变了 42.1%的患者的治疗方案。在透明细胞 RCC 患者中，检测效果最强。本研究结果表明，在 RCC 的分期中使用该方法可能具有一定价值。需要进一步分析，包括组织学确认、疗效和成本效益，以确定是否有必要常规进行 Ga-PSMA PET/CT 成像。
