Jochumsen Mads Ryø, Sörensen Jens, Tolbod Lars Poulsen, Pedersen Bodil Ginnerup, Frøkiær Jørgen, Borre Michael, Bouchelouche Kirsten
Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
EJNMMI Res. 2021 Feb 9;11(1):12. doi: 10.1186/s13550-021-00757-y.
Both prostate-specific membrane antigen (PSMA) uptake and tumour blood flow (TBF) correlate with International Society of Urological Pathology (ISUP) Grade Group (GG) and hence prostate cancer (PCa) aggressiveness. The aim of the present study was to evaluate the potential synergistic benefit of combining the two physiologic parameters for separating significant PCa from insignificant findings.
From previous studies of [Rb]Rb positron emission tomography (PET) TBF in PCa, the 43 patients that underwent clinical [Ga]Ga-PSMA-11 PET were selected for this retrospective study. Tumours were delineated on [Ga]Ga-PSMA-11 PET or magnetic resonance imaging. ISUP GG was recorded from 52 lesions.
[Ga]Ga-PSMA-11 maximum standardized uptake value (SUVmax) and [Rb]Rb SUVmax correlated moderately with ISUP GG (rho = 0.59 and rho = 0.56, both p < 0.001) and with each other (r = 0.65, p < 0.001). A combined model of [Ga]Ga-PSMA-11 and [Rb]Rb SUVmax separated ISUP GG > 2 from ISUP GG 1-2 and benign with an area-under-the-curve of 0.85, 96% sensitivity, 74% specificity, and 95% negative predictive value. The combined model performed significantly better than either tracer alone did (p < 0.001), primarily by reducing false negatives from five or six to one (p ≤ 0.025).
PSMA uptake and TBF provide complementary information about tumour aggressiveness. We suggest that a combined analysis of PSMA uptake and TBF could significantly improve the negative predictive value and allow non-invasive separation of significant from insignificant PCa.
前列腺特异性膜抗原（PSMA）摄取和肿瘤血流（TBF）均与国际泌尿病理学会（ISUP）分级组（GG）相关，因此与前列腺癌（PCa）的侵袭性相关。本研究的目的是评估将这两个生理参数结合起来以区分有意义的PCa与无意义的检查结果的潜在协同效益。
从先前关于PCa中[Rb]Rb正电子发射断层扫描（PET）TBF的研究中，选择43例行临床[Ga]Ga-PSMA-11 PET检查的患者进行这项回顾性研究。在[Ga]Ga-PSMA-11 PET或磁共振成像上勾勒出肿瘤。记录了52个病灶的ISUP GG。
[Ga]Ga-PSMA-11最大标准化摄取值（SUVmax）和[Rb]Rb SUVmax与ISUP GG中度相关（rho = 0.59和rho = 0.56，均p < 0.001），且彼此相关（r = 0.65，p < 0.001）。[Ga]Ga-PSMA-11和[Rb]Rb SUVmax的联合模型将ISUP GG > 2与ISUP GG 1 - 2及良性病变区分开来，曲线下面积为0.85，灵敏度为96%，特异性为74%，阴性预测值为95%。联合模型的表现明显优于单独使用任何一种示踪剂（p < 0.001），主要是通过将假阴性从五六个减少到一个（p ≤ 0.025）。
PSMA摄取和TBF提供了关于肿瘤侵袭性的互补信息。我们建议对PSMA摄取和TBF进行联合分析可显著提高阴性预测值，并允许非侵入性地区分有意义的与无意义的PCa。
