Lopci E, Lughezzani G, Castello A, Colombo P, Casale P, Saita A, Buffi N M, Guazzoni G, Chiti A, Lazzeri M
Nuclear-Medicine, Humanitas Clinical and Research Hospital-IRCCS, Rozzano, MI, Italy.
Department of Urology, Humanitas Clinical and Research Hospital-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.
Clin Transl Oncol. 2021 Jan;23(1):172-178. doi: 10.1007/s12094-020-02384-w. Epub 2020 May 23.
To compare the diagnostic performance of Ga-PSMA PET/TC with PRI-MUS (prostate risk identification using micro-ultrasound) in the primary diagnosis of prostate cancer (PCa).
From September till December 2018, we prospectively enrolled 25 candidates to Ga-PSMA PET/TRUS (transrectal ultrasound) fusion biopsy and compared them with PRI-MUS. This included patients with persistently elevated PSA and/or PHI (prostate health index) suspicious for PCa, negative digital rectal examination, with either negative or contraindication to mpMRI, and at least one negative biopsy. The diagnostic performance of the two modalities was calculated based on pathology results.
Overall, 20 patients were addressed to Ga-PSMA PET/TRUS fusion biopsy. Mean SUVmax and SUVratio for PCa lesions resulted significantly higher than in benign lesions (p = 0.041 and 0.011, respectively). Using optimal cut-off points, Ga-PSMA PET/CT demonstrated an overall accuracy of 83% for SUVmax ≥ 5.4 and 94% for SUVratio ≥ 2.2 in the detection of clinically significant PCa (GS ≥ 7). On counterpart, PRI-MUS results were: score 3 in nine patients (45%), score 4 in ten patients (50%), and one patient with score 5. PRI-MUS score 4 and 5 demonstrated an overall accuracy of 61% in detecting clinically significant PCa.
In this highly-selected patient population, in comparison to PRI-MUS, Ga-PSMA PET/CT shows a higher diagnostic performance.
比较镓-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）与原发性前列腺癌风险评估微超声（PRI-MUS）在前列腺癌（PCa）初诊中的诊断性能。
2018年9月至12月，我们前瞻性纳入25例接受Ga-PSMA PET/经直肠超声（TRUS）融合活检的患者，并将其与PRI-MUS进行比较。这包括前列腺特异性抗原（PSA）和/或前列腺健康指数（PHI）持续升高且怀疑患有PCa、直肠指检阴性、多参数磁共振成像（mpMRI）为阴性或有禁忌证以及至少一次活检阴性的患者。基于病理结果计算两种检查方法的诊断性能。
总体而言，20例患者接受了Ga-PSMA PET/TRUS融合活检。PCa病变的平均最大标准摄取值（SUVmax）和SUV比率显著高于良性病变（p分别为0.041和0.011）。使用最佳截断点，在检测临床显著PCa（Gleason评分≥7）时，Ga-PSMA PET/CT对于SUVmax≥5.4的总体准确率为83%，对于SUV比率≥2.2的总体准确率为94%。相比之下，PRI-MUS的结果为：9例患者评分为3分（45%），10例患者评分为4分（50%），1例患者评分为5分。PRI-MUS评分为4分和5分在检测临床显著PCa时的总体准确率为61%。
在这一经过高度筛选的患者群体中，与PRI-MUS相比，Ga-PSMA PET/CT显示出更高的诊断性能。
