Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
J Nucl Med. 2020 Jun;61(6):881-889. doi: 10.2967/jnumed.119.234799. Epub 2019 Nov 1.
Our objective was to investigate the lesion detection rate of F-DCFPyL PET/CT, a prostate-specific membrane antigen (PSMA)-targeted PET agent, in patients with biochemically relapsed prostate cancer after primary local therapy. This was a prospective institutional review board-approved study of 90 patients with documented biochemical recurrence (median prostate-specific antigen [PSA], 2.5 ng/mL; range, 0.21-35.5 ng/mL) and negative results on conventional imaging after primary local therapies, including radical prostatectomy ( = 38), radiation ( = 27), or a combination of the two ( = 25). Patients on androgen deprivation therapy were excluded. Patients underwent whole-body F-DCFPyL PET/CT (299.9 ± 15.5 MBq) at 2 h after injection. The PSMA PET lesion detection rate was correlated with PSA, PSA kinetics, and original primary tumor grade. Seventy patients (77.8%) showed positive PSMA PET results, with a total of 287 lesions identified: 37 prostate bed foci, 208 lesions in lymph nodes, and 42 in distant sites in bones or organs, Eleven patients had negative results, and 9 patients showed indeterminate lesions, which were considered negative in this study. The detection rates were 47.6% ( = 10/21), 50% ( = 5/10), 88.9% ( = 8/9), and 94% ( = 47/50) for PSA levels of >0.2 to <0.5, 0.5 to <1.0, 1 to <2.0, and ≥2.0 ng/mL, respectively. In postsurgical patients, PSA, PSA doubling time, and PSA velocity correlated with PET results, but the same was not true for postradiation patients. These parameters also correlated with the extent of disease on PET (intrapelvic vs. extrapelvic). There was no significant difference in the rate of positive scans between patients with higher-grade and lower-grade primary tumors (Gleason score of ≥4 + 3 vs. <3 + 4). Tumor recurrence was histology-confirmed in 40% (28/70) of patients. On a per-patient basis, positive predictive value was 93.3% (95% confidence interval, 77.6%-99.2%) by histopathologic validation and 96.2% (95% confidence interval, 86.3%-99.7%) by the combination of histology and imaging/clinical follow-up. F-DCFPyL PET/CT imaging offers high detection rates in biochemically recurrent prostate cancer patients and is positive in about 50% of patients with a PSA level of less than 0.5 ng/mL, which could substantially impact clinical management. In postsurgical patients, F-DCFPyL PET/CT correlates with PSA, PSA doubling time, and PSA velocity, suggesting it may have prognostic value. F-DCFPyL PET/CT is highly promising for localizing sites of recurrent prostate cancer.
我们的目的是研究 F-DCFPyL PET/CT 在原发性局部治疗后生化复发的前列腺癌患者中的病变检测率，F-DCFPyL PET/CT 是一种前列腺特异性膜抗原（PSMA）靶向的 PET 制剂。这是一项前瞻性机构审查委员会批准的研究，纳入了 90 名有记录的生化复发（中位前列腺特异性抗原 [PSA]，2.5ng/mL；范围，0.21-35.5ng/mL）和原发性局部治疗后常规影像学检查结果阴性的患者，包括根治性前列腺切除术（=38）、放疗（=27）或两者联合（=25）。正在接受雄激素剥夺治疗的患者被排除在外。患者在注射后 2 小时进行全身 F-DCFPyL PET/CT（299.9±15.5MBq）检查。PSMA PET 病变检测率与 PSA、PSA 动力学和原始原发性肿瘤分级相关。70 名患者（77.8%）的 PSMA PET 结果呈阳性，共发现 287 个病变：37 个前列腺床病灶、208 个淋巴结病灶和 42 个远处骨骼或器官病灶。11 名患者结果为阴性，9 名患者结果为不确定，在本研究中这些结果被认为是阴性。PSA 水平分别为>0.2 至<0.5ng/mL、0.5 至<1.0ng/mL、1.0 至<2.0ng/mL和≥2.0ng/mL 时，检测率分别为 47.6%（=10/21）、50%（=5/10）、88.9%（=8/9）和 94%（=47/50）。在接受手术治疗的患者中，PSA、PSA 倍增时间和 PSA 速度与 PET 结果相关，但在接受放疗的患者中并非如此。这些参数也与 PET 上疾病的严重程度相关（盆腔内与盆腔外）。在原发性肿瘤分级较高和较低的患者中，阳性扫描率没有显著差异（Gleason 评分≥4+3 与<3+4）。40%（28/70）的患者通过组织学证实了肿瘤复发。基于患者的检测率，组织学验证的阳性预测值为 93.3%（95%置信区间，77.6%-99.2%），组织学和影像学/临床随访联合验证的阳性预测值为 96.2%（95%置信区间，86.3%-99.7%）。F-DCFPyL PET/CT 成像在生化复发的前列腺癌患者中具有较高的检测率，在 PSA 水平<0.5ng/mL 的患者中约有 50%为阳性，这可能对临床管理产生重大影响。在接受手术治疗的患者中，F-DCFPyL PET/CT 与 PSA、PSA 倍增时间和 PSA 速度相关，表明其可能具有预后价值。F-DCFPyL PET/CT 非常有希望用于定位复发性前列腺癌的部位。
