Simsek Duygu Has, Sanli Yasemin, Engin Muge Nur, Erdem Selcuk, Sanli Oner
Istanbul Faculty of Medicine, Department of Nuclear Medicine, Istanbul University, 34093, İstanbul, Fatih, Turkey.
Istanbul Faculty of Medicine, Department of Urology, Istanbul University, 34093, İstanbul, Fatih, Turkey.
Eur J Nucl Med Mol Imaging. 2021 May;48(5):1639-1649. doi: 10.1007/s00259-020-04995-5. Epub 2020 Aug 13.
We aimed to investigate the diagnostic power of 68Ga-PSMA PET/CT in the detection of metastatic spread of newly diagnosed PCa, and evaluate the relationship with modified D'Amico risk classification.
We evaluated newly diagnosed PCa patients who underwent 68Ga-PSMA PET/CT prior to therapy. All images were interpreted retrospectively and areas of abnormally increased tracer uptake were documented according to PSMA-RADS version 1.0 system. Patients were divided into risk groups as low, intermediate, or high risk, according to a modification in D'Amico classification system as ISUP grade 3 tumors were included to high-risk group. 68Ga-PSMA PET/CT findings were compared among risk groups as well as PSA levels, clinical T stages, and ISUP grades.
A total of 356 patients were included to the study with a median PSA level was 16.42 (1.29-7013) ng/ml and median Gleason score was 8 (range: 6-10). Of these, 13(3.7%), 54 (15.1%), and 289 (81.2%) were in the low-, intermediate-, and high-risk groups, respectively. Lymph node metastases were detected in 125 (35.1%) patients, and in 48 of them, metastasis was limited to pelvic lymph nodes (PLN). Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated as 71.4%, 100%, 95.9%, 100%, and 95.4%, respectively for the detection of PLN, based on histopathological results of 49 patients. Overall, any metastasis was detected in 47.7% of high-risk patients, while only PLN metastases were defined in 3.7% intermediate-risk patients and none of low-risk patients had any kind of metastasis.
This study revealed that 68Ga-PSMA PET/CT should be routinely used in newly diagnosed high-risk PCa patients; whereas it seems to be of limited use for intermediate-risk group and useless for the low-risk group.
我们旨在研究68Ga-PSMA PET/CT在检测新诊断前列腺癌转移扩散方面的诊断能力，并评估其与改良的达米科风险分类的关系。
我们评估了在治疗前接受68Ga-PSMA PET/CT检查的新诊断前列腺癌患者。所有图像均进行回顾性解读，并根据PSMA-RADS 1.0版系统记录示踪剂摄取异常增加的区域。根据对达米科分类系统的修改，将患者分为低、中、高风险组，即国际泌尿病理学会（ISUP）3级肿瘤被纳入高风险组。比较风险组之间的68Ga-PSMA PET/CT结果以及前列腺特异性抗原（PSA）水平、临床T分期和ISUP分级。
共有356例患者纳入研究，PSA水平中位数为16.42（1.29 - 7013）ng/ml，Gleason评分中位数为8（范围：6 - 10）。其中，低、中、高风险组分别有13例（3.7%）、54例（15.1%）和289例（81.2%）。125例（35.1%）患者检测到淋巴结转移，其中48例转移局限于盆腔淋巴结（PLN）。基于49例患者的组织病理学结果，检测PLN的敏感性、特异性、准确性、阳性预测值和阴性预测值分别计算为71.4%、100%、95.9%、100%和95.4%。总体而言，47.7%的高风险患者检测到任何转移，而中风险患者中仅3.7%定义为PLN转移，低风险患者均无任何类型的转移。
本研究表明，68Ga-PSMA PET/CT应常规用于新诊断的高风险前列腺癌患者；而对于中风险组似乎用途有限，对低风险组则无用。
