F-DCFPyL正电子发射断层扫描/计算机断层扫描对生化复发前列腺癌的诊断性能及治疗方案变更分析
Diagnostic performance of F-DCFPyL positron emission tomography/computed tomography for biochemically recurrent prostate cancer and change-of-management analysis.
作者信息
Chaussé Guillaume, Ben-Ezra Noah, Stoopler Michelle, Levett Jeremy Y, Niazi Tamim, Anidjar Maurice, Abikhzer Gad, Probst Stephan
机构信息
Nuclear Medicine, Medical Imaging, Jewish General Hospital, McGill University, Montreal, QC, Canada.
Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
出版信息
Can Urol Assoc J. 2021 Jun;15(6):173-178. doi: 10.5489/cuaj.6817.
INTRODUCTION
Conventional imaging (CI) performs poorly to identify sites of disease in biochemically recurrent prostate cancer. Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) is most studied but has a very short half-life. This study reports the diagnostic performance of the novel prostate-specific membrane antigen (PSMA) radiotracer F-DCFPyL using real-life data and tumor board simulation to estimate the impact of F-DCFPyL PET on patient management.
METHODS
Ninety-three F-DCFPyL PET/CT scans performed for patients previously treated for prostate cancer with a rising prostate-specific antigen (PSA) were retrospectively compared to contemporary CI and clinical imaging and PSA followups. A chart review was performed to document prior imaging, pathology results, serial serum PSA measurements, and other pertinent clinical data. Clinical utility of F-DCFPyL PET was measured using a simulated tumor board formed by three physicians with extensive prostate cancer experience deciding on management with and without knowledge of PET/CT results.
RESULTS
At median PSA 2.27 (interquartile rage [IQR] 5.27], 82% of F-DCFPyL PET/CT demonstrated at least one site of disease: non-regional lymph nodes (37% of scans), regional lymph node metastases (28%), local recurrence (27%), and bone metastases (20%), with higher PET positivity at higher PSA. Compared to F-DCFPyL PET/CT, CI showed overall poor performance, with accuracy below 20% for all extent of disease. PET/CT changed management in 44% of cases. The most frequent scenario was a radical change from initiating androgen deprivation therapy (ADT) to stereotactic body radiotherapy (SBRT) of oligo-lesional disease. In univariate and multivariate analysis, no patient characteristic could predict change of management by PET/CT results.
CONCLUSIONS
F-DCFPyL significantly outperforms CI in recurring prostate cancer and is likely to impact management.
引言
传统成像（CI）在识别生化复发前列腺癌的疾病部位方面表现不佳。镓-PSMA-11正电子发射断层扫描/计算机断层扫描（PET/CT）研究最多，但半衰期很短。本研究报告了新型前列腺特异性膜抗原（PSMA）放射性示踪剂F-DCFPyL的诊断性能，使用实际数据和肿瘤病例讨论模拟来评估F-DCFPyL PET对患者管理的影响。
方法
对93例先前接受过前列腺癌治疗且前列腺特异性抗原（PSA）升高的患者进行的F-DCFPyL PET/CT扫描进行回顾性分析，并与当代CI、临床成像和PSA随访结果进行比较。查阅病历以记录先前的成像、病理结果、系列血清PSA测量值和其他相关临床数据。F-DCFPyL PET的临床实用性通过由三名具有丰富前列腺癌经验的医生组成的模拟肿瘤病例讨论来衡量，他们在知晓和不知晓PET/CT结果的情况下决定治疗方案。
结果
在PSA中位数为2.27（四分位间距[IQR]为5.27）时，82%的F-DCFPyL PET/CT显示至少一个疾病部位：非区域淋巴结（扫描的37%）、区域淋巴结转移（28%）、局部复发（27%）和骨转移（20%），PSA越高，PET阳性率越高。与F-DCFPyL PET/CT相比，CI总体表现不佳，对所有疾病范围的准确率均低于20%。PET/CT在44%的病例中改变了治疗方案。最常见的情况是从开始雄激素剥夺治疗（ADT）彻底转变为对寡转移疾病进行立体定向体部放疗（SBRT）。在单因素和多因素分析中，没有患者特征能够预测PET/CT结果对治疗方案的改变。
结论
在复发性前列腺癌中，F-DCFPyL明显优于CI，并且可能会影响治疗方案。
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