Chen Ruohua, Wang Yining, Zhu Yinjie, Shi Yiping, Xu Lian, Huang Gang, Liu Jianjun
Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China.
Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China.
J Nucl Med. 2021 Apr 23. doi: 10.2967/jnumed.121.262250.
The Ga-PSMA PET/CT is a commonly used imaging modality in prostate cancers. However, few studies have compared the diagnostic efficiency between Ga-PSMA and F-FDG PET/CT and evaluated whether a heterogeneous metabolic phenotype (especially PSMA-FDG+ lesions) exists in patients with castration-resistant prostate cancer (CRPC). We determined the added value of F-FDG PET/CT compared to Ga-PSMA PET/CT in CRPC patients and identified CRPC patients who may benefit from additional F-FDG PET/CT. Data of 56 patients with CRPC who underwent both Ga-PSMA and F-FDG PET/CT from May 2018 to February 2021 were retrospectively analysed. Patients were classified into two groups with or without PSMA-FDG+ lesions. The differences in patient characteristics between the two groups and predictors of patients who having at least one PSMA-FDG+ lesion were analysed. Although both the detection rate (75.0% vs. 51.8%, = 0.004) and positive lesion number (135 vs. 95) of Ga-PSMA PET/CT were higher than F-FDG PET/CT, there were still 13/56 (23.2%) patients with at least one PSMA-FDG+ lesion. The prostate-specific antigen (PSA) and Gleason score were both higher in the patients with PSMA-FDG+ lesions than in those without PSMA-FDG+ lesions ( = 0.04 and P<0.001, respectively). Multivariate regression analysis showed that the Gleason score (≥8) and PSA (≥7.9 ng/mL) were associated with the detection rate of patients who had PSMA-FDG+ lesions ( = 0.01 and = 0.04, respectively). The incidences of having PSMA-FDG+ lesions in low-probability (Gleason score<8 and PSA<7.9 ng/mL), medium-probability (Gleason score≥8 and PSA<7.9 ng/mL or Gleason score<8 and PSA≥7.9 ng/mL), and high-probability (Gleason score≥8 and PSA≥7.9 ng/mL) groups were 0%, 21.7%, and 61.5%, respectively (P<0.001). Gleason score and PSA are significant predictors for PSMA-FDG+ lesions, and CRPC patients with high Gleason score and PSA may benefit from additional F-FDG PET/CT.
镓-PSMA PET/CT是前列腺癌常用的成像方式。然而，很少有研究比较镓-PSMA与F-FDG PET/CT之间的诊断效率，也未评估去势抵抗性前列腺癌（CRPC）患者中是否存在异质性代谢表型（尤其是PSMA-FDG+病变）。我们确定了F-FDG PET/CT相对于镓-PSMA PET/CT在CRPC患者中的附加值，并识别出可能从额外的F-FDG PET/CT中获益的CRPC患者。回顾性分析了2018年5月至2021年2月期间接受镓-PSMA和F-FDG PET/CT检查的56例CRPC患者的数据。患者被分为有或无PSMA-FDG+病变的两组。分析了两组患者特征的差异以及至少有一个PSMA-FDG+病变患者的预测因素。尽管镓-PSMA PET/CT的检出率（75.0%对51.8%，P = 0.004）和阳性病变数量（135对95）均高于F-FDG PET/CT，但仍有13/56（23.2%）的患者至少有一个PSMA-FDG+病变。有PSMA-FDG+病变的患者前列腺特异性抗原（PSA）和 Gleason评分均高于无PSMA-FDG+病变的患者（分别为P = 0.04和P<0.001）。多因素回归分析显示，Gleason评分（≥8）和PSA（≥7.9 ng/mL）与有PSMA-FDG+病变患者的检出率相关（分别为P = 0.01和P = 0.04）。低概率（Gleason评分<8且PSA<7.9 ng/mL）、中概率（Gleason评分≥8且PSA<7.9 ng/mL或Gleason评分<8且PSA≥7.9 ng/mL）和高概率（Gleason评分≥8且PSA≥7.9 ng/mL）组中出现PSMA-FDG+病变的发生率分别为0%、21.7%和61.5%（P<0.001）。Gleason评分和PSA是PSMA-FDG+病变的重要预测因素，Gleason评分高且PSA高的CRPC患者可能从额外的F-FDG PET/CT中获益。
