Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre.
Sir Peter MacCallum Department of Oncology, University of Melbourne.
Curr Opin Urol. 2020 Sep;30(5):628-634. doi: 10.1097/MOU.0000000000000799.
Molecular imaging with PET/CT targeting the prostate-specific membrane antigen (PSMA) receptor is increasingly utilized in men with prostate cancer (PCa), with clinical indications now expanding beyond biochemical recurrence. PSMA PET/CT often detects sub-centimetre size pathologic nodes and low-volume bone marrow disease that are occult on conventional imaging when the lesion does not cause sclerosis or osteoblastic reaction in surrounding bone. This review focuses on recent evidence for PSMA PET/CT in initial disease staging.
Several recent studies including a large randomized trial have evaluated the clinical impact of PSMA PET/CT in initial staging of PCa. PSMA PET/CT is more sensitive and accurate than the conventional imaging standard of CT and bone scan. Change in treatment plan or modality of therapy occurs frequently when PSMA PET/CT forms part of the diagnostic algorithm. Hybrid PET/MRI also has potential utility, particularly in evaluating pelvic disease, but evidence base remains very limited.
PSMA PET/CT has emerged as a new standard in primary staging of PCa. Reimbursement by national funding bodies and incorporation into international clinical guidelines is anticipated within the next few years.
正电子发射断层扫描/计算机断层扫描（PET/CT）通过靶向前列腺特异性膜抗原（PSMA）受体进行分子成像，在前列腺癌（PCa）患者中的应用日益广泛，目前其临床适应证已扩展至生化复发以外的情况。PSMA PET/CT 常用于检测亚厘米大小的病理性淋巴结和骨髓疾病，当病变未导致周围骨出现硬化或成骨反应时，这些病变在常规影像学检查中是隐匿的。本文重点介绍 PSMA PET/CT 在疾病初始分期中的最新证据。
包括一项大型随机试验在内的几项最新研究评估了 PSMA PET/CT 在 PCa 初始分期中的临床价值。与 CT 和骨扫描的常规影像学标准相比，PSMA PET/CT 具有更高的敏感性和准确性。当 PSMA PET/CT 成为诊断算法的一部分时，治疗方案或治疗方式的改变经常发生。混合 PET/MRI 也具有潜在的应用价值，特别是在评估盆腔疾病方面，但目前的证据基础仍然非常有限。
PSMA PET/CT 已成为 PCa 初始分期的新标准。预计在未来几年内，国家资助机构将对此进行报销，并将其纳入国际临床指南。
