Liu Ao, Zhang Miao, Huang Hai, Zhang Chuanjie, Ruan Xiaohao, Lin Wenhao, Li Biao, Chen Lu, Xu Danfeng
Department of Urinary Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Front Oncol. 2021 Feb 11;10:612701. doi: 10.3389/fonc.2020.612701. eCollection 2020.
This study aimed to evaluate the clinical utility of F-PSMA-1007 positron emission tomography (PSMA PET)/magnetic resonance imaging (MRI) imaging in patients with suspected or defined prostate cancer.
In the pilot study, we retrospectively investigated 62 patients who underwent PSMA-PET/MRI for suspected or defined PCa between June 2019 and June 2020. Patients were grouped into three subgroups: (1) suspected PCa without histological evidence, (2) primary PCa, (3) biochemical recurrent prostate cancer (BRPCa). Two nuclear physicians independently interpreted the results of PSMA-PET/MRI. Management strategies before PSMA-PET/MRI were retrospectively reported, and the management strategy was re-evaluated for each patient considering the PSMA-PET/MRI result. The changes in strategies were recorded. Besides, the correlation between prostate specific antigen (PSA) level and management changes was also accessed by Fisher exact test, and two-side p < 0.05 was assumed as statistical significance.
There were 28 patients in the suspected PCa group (group 1), 12 in the primary PCa group (group 2), and 22 in the BRPCa group (group 3). Overall, the intended decisions were changed in 26 (41.9%) of 62 patients after PSMA-PET/MRI, including 11/28 (39.3%) in suspected PCa group, 1/12 (8.4%) in primary PCa group, and 14/24 (63.6%) in BCR group. In group 1, the main impact on subsequent management included decreased active surveillance (from 20 to 9) and increased prostate biopsy (from 8 to 19). PSA levels were not significantly associated with management changes in suspected PCa patients (p = 0.865). In group 2, the main impact on subsequent management included decreased radical surgery (from 8 to 7), and multimodal therapy appearance (n = 1). Only in the category of PSA levels of ≥20 ng/ml, the management of primary PCa was changed. In group 3, the main impact on subsequent management included decreased salvage radiotherapy (from 5 to 2), increased systemic therapy (from 6 to 7), and increased multimodal therapy (from 11 to 13). The highest proportion of management changes occurred in BCR patients with 0.5≤PSA<1 ng/ml.
From our preliminary experience, PSMA-PET/MRI may be a valued tool for defining PCa lesions and changing management. The biggest impact of management intent was in patients with BRPCa, especially in patients with 0.5≤PSA<1 ng/ml. However, further studies are needed to confirm our pilot findings.
本研究旨在评估F-PSMA-1007正电子发射断层扫描（PSMA PET）/磁共振成像（MRI）成像在疑似或确诊前列腺癌患者中的临床应用价值。
在这项初步研究中，我们回顾性调查了2019年6月至2020年6月期间因疑似或确诊前列腺癌而接受PSMA-PET/MRI检查的62例患者。患者被分为三个亚组：（1）无组织学证据的疑似前列腺癌，（2）原发性前列腺癌，（3）生化复发前列腺癌（BRPCa）。两名核医学医师独立解读PSMA-PET/MRI的结果。回顾性报告PSMA-PET/MRI检查前的管理策略，并根据PSMA-PET/MRI结果对每位患者的管理策略进行重新评估。记录策略的变化。此外，还通过Fisher精确检验评估前列腺特异性抗原（PSA）水平与管理变化之间的相关性，双侧p<0.05被视为具有统计学意义。
疑似前列腺癌组（第1组）有28例患者，原发性前列腺癌组（第2组）有12例患者，BRPCa组（第3组）有22例患者。总体而言，62例患者中有26例（41.9%）在PSMA-PET/MRI检查后其预期决策发生了改变，包括疑似前列腺癌组中的11/28例（39.3%），原发性前列腺癌组中的1/12例（8.4%），以及BCR组中的14/24例（63.6%）。在第1组中，对后续管理的主要影响包括主动监测减少（从20例降至9例）和前列腺活检增加（从8例增至19例）。疑似前列腺癌患者的PSA水平与管理变化无显著相关性（p = 0.865）。在第2组中，对后续管理的主要影响包括根治性手术减少（从8例降至7例）和多模式治疗出现（n = 1）。仅在PSA水平≥20 ng/ml的类别中，原发性前列腺癌的管理发生了改变。在第3组中，对后续管理的主要影响包括挽救性放疗减少（从5例降至2例）、全身治疗增加（从6例增至7例）和多模式治疗增加（从11例增至13例）。管理变化比例最高的是PSA为0.5≤PSA<1 ng/ml的BRPCa患者。
根据我们的初步经验，PSMA-PET/MRI可能是用于明确前列腺癌病变和改变管理的有价值工具。管理意图受影响最大的是BRPCa患者，尤其是PSA为0.5≤PSA<1 ng/ml的患者。然而，需要进一步研究来证实我们的初步发现。
