Kuten Jonathan, Dekalo Snir, Mintz Ishai, Yossepowitch Ofer, Mano Roy, Even-Sapir Einat
Departments of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel-Aviv, Israel.
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
EJNMMI Res. 2021 Jan 6;11(1):3. doi: 10.1186/s13550-020-00745-8.
Assessing the extent of disease in newly diagnosed prostate cancer (PC) patients is crucial for tailoring an appropriate treatment approach. Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography/computed tomography (PET/CT) reportedly has greater accuracy than conventional imaging for staging PC. As with any imaging modality, pitfalls and nonspecific findings do occur. The PSMA reporting and data system (PSMA-RADS) version 1.0 offers structured interpretation of PSMA-targeted studies and classifies lesions by likelihood of clinical significance. The aim of this retrospective study was to evaluate the clinical significance of equivocal bone findings on staging PSMA-targeted imaging, as defined by PSMA-RADS version 1.0, in the preoperative setting. Fifteen of 406 consecutive patients staged by PET/CT prior to radical prostatectomy had equivocal bone lesions. The scans were retrospectively scored with the PSMA-RADS version 1.0 system, blinded to disease course and follow-up data. Postoperative persistence of prostate-specific antigen levels supported by imaging and histological findings was used as the reference standard for the true significance of equivocal imaging findings.
Thirteen of the 15 patients had an overall PSMA-RADS score of 3B, of whom only two had true metastatic disease. The remaining patients had scores of 4 (n = 1) or 5 (n = 1), all confirmed as true positive prostate-related malignant lesions. A per-lesion analysis identified 29 bone lesions, of which 27 were scored PSMA-RADS 3B, and only three of them were true metastases. Thus, debatable lesions proved to have no clinical significance in 84.6% of cases, and only 11% of equivocal PSMA-RADS 3B bone lesions were true positive.
In intermediate and high-risk patients staged prior to radical prostatectomy, the majority of PSMA-RADS 3B lesions are of no clinical relevance. Bone lesions judged as being highly suspicious for metastases (PSMA-RADS 4/5) were all validated as true positives.
评估新诊断前列腺癌（PC）患者的疾病范围对于制定合适的治疗方案至关重要。据报道，前列腺特异性膜抗原（PSMA）靶向正电子发射断层扫描/计算机断层扫描（PET/CT）在PC分期方面比传统成像具有更高的准确性。与任何成像方式一样，也会出现陷阱和非特异性发现。PSMA报告和数据系统（PSMA-RADS）1.0版提供了对PSMA靶向研究的结构化解读，并根据临床意义的可能性对病变进行分类。这项回顾性研究的目的是评估术前PSMA靶向成像中，根据PSMA-RADS 1.0版定义的可疑骨病变的临床意义。在406例接受根治性前列腺切除术前行PET/CT分期的连续患者中，有15例存在可疑骨病变。对扫描结果采用PSMA-RADS 1.0系统进行回顾性评分，对疾病进程和随访数据进行盲法处理。影像学和组织学检查结果支持的术后前列腺特异性抗原水平持续存在，被用作可疑影像学检查结果真正意义的参考标准。
15例患者中有13例的PSMA-RADS总评分为3B，其中只有2例有真正的转移性疾病。其余患者评分为4分（n = 1）或5分（n = 1），均被确认为真正的前列腺相关恶性阳性病变。逐病变分析确定了29个骨病变，其中27个评分为PSMA-RADS 3B，其中只有3个是真正的转移灶。因此，在84.6%的病例中，可疑病变被证明无临床意义，PSMA-RADS 3B的可疑骨病变中只有11%为真正的阳性。
在根治性前列腺切除术前行分期的中高危患者中，大多数PSMA-RADS 3B病变无临床相关性。被判定为高度怀疑转移的骨病变（PSMA-RADS 4/5）均被确认为真正的阳性。
