镓-PSMA-11 PET 成像在持续雄激素剥夺治疗的晚期前列腺癌患者中的应用。
Ga-PSMA-11 PET imaging in patients with ongoing androgen deprivation therapy for advanced prostate cancer.
机构信息
Department of Urology, University Hospital Zürich, University of Zürich, Zurich, Switzerland.
Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zurich, Switzerland.
出版信息
Ann Nucl Med. 2021 Oct;35(10):1109-1116. doi: 10.1007/s12149-021-01646-z. Epub 2021 Jun 29.
PURPOSE
Prostate-specific membrane antigen (PSMA) targeted positron emission tomography (PET) imaging significantly improved the detection of recurrent prostate cancer (PCa). However, the value of PSMA PET imaging in patients with advanced hormone-sensitive or hormone-resistant PCa is still largely unknown. The aim of this study was to analyze the detection rate and distribution of lesions using PSMA PET imaging in patients with advanced PCa and ongoing androgen deprivation therapy (ADT).
METHODS
A total of 84 patients diagnosed with hormone-sensitive or hormone-resistant PCa who underwent Ga-PSMA-11 PET/magnetic resonance imaging (MRI) or computer tomography (CT) under ongoing ADT were retrospectively analyzed. We assessed the detection of PSMA-positive lesions overall and for three PSA subgroups (0 to < 1 ng/mL, 1 to < 20 ng/mL and > 20 ng/mL). In addition, PSMA-positive findings were stratified by localization (prostatic fossa, pelvic, para-aortic, mediastinal/supraclavicular and axillary lymph nodes, bone lesions and visceral lesions) and hormone status (hormone-sensitive vs. hormone-resistant). Furthermore, we assessed how many patients would be classified as having oligometastatic disease (≤ 3 lesions) and theoretically qualify for metastasis-directed radiotherapy (MDRT) in a personalized patient management.
RESULTS
We detected PSMA-positive lesions in 94.0% (79 of 84) of all patients. In the three PSA subgroups detection rates of 85.2% (0 to < 1 ng/mL, n = 27), 97.3% (1 to < 20 ng/mL, n = 37) and 100% (> 20 ng/mL, n = 20) were observed, respectively. PSMA-positive visceral metastases were observed only in patients with a PSA > 1 ng/mL. Detection of PSMA-positive lesions did not significantly differ between patients with hormone-sensitive and hormone-resistant PCa. Oligometastatic PCa was detected in 19 of 84 patients (22.6%). Almost all patients, 94.7% (n = 18) would have been eligible for MDRT.
CONCLUSIONS
In this study, we observed an overall very high detection rate of 94% using PSMA PET imaging in patients with advanced PCa and ongoing ADT. Even in a majority of patients with very low PSA values < 1 ng/ml PSMA-positive lesions were found.
目的
前列腺特异性膜抗原（PSMA）靶向正电子发射断层扫描（PET）成像显著提高了复发性前列腺癌（PCa）的检测率。然而，PSMA PET 成像在晚期激素敏感或激素抵抗性 PCa 患者中的价值仍知之甚少。本研究旨在分析接受持续雄激素剥夺治疗（ADT）的晚期 PCa 患者中使用 PSMA PET 成像检测病灶的检出率和分布。
方法
回顾性分析 84 例接受 Ga-PSMA-11 PET/磁共振成像（MRI）或计算机断层扫描（CT）检查的激素敏感或激素抵抗性 PCa 患者的资料，这些患者均在持续 ADT 下进行。我们评估了 PSMA 阳性病变的总体检出率，以及三个 PSA 亚组（0 至<1ng/ml、1 至<20ng/ml 和>20ng/ml）的检出率。此外，根据定位（前列腺窝、骨盆、腹主动脉旁、纵隔/锁骨上和腋窝淋巴结、骨病变和内脏病变）和激素状态（激素敏感与激素抵抗）对 PSMA 阳性发现进行分层。此外，我们评估了有多少患者会被归类为寡转移疾病（≤3 个病灶），并在个性化患者管理中理论上有资格接受转移灶定向放疗（MDRT）。
结果
我们在所有 84 例患者中均检测到 PSMA 阳性病变，检出率为 94.0%（79/84）。在三个 PSA 亚组中，检出率分别为 85.2%（0 至<1ng/ml，n=27）、97.3%（1 至<20ng/ml，n=37）和 100%（>20ng/ml，n=20）。仅在 PSA>1ng/ml 的患者中观察到 PSMA 阳性内脏转移。PSMA 阳性病变的检出率在激素敏感和激素抵抗性 PCa 患者之间无显著差异。在 84 例患者中检测到 19 例寡转移 PCa（22.6%）。几乎所有患者（94.7%，n=18）均有资格接受 MDRT。
结论
在这项研究中，我们观察到在接受持续 ADT 的晚期 PCa 患者中，使用 PSMA PET 成像的总体检测率非常高，为 94%。即使在大多数 PSA 值<1ng/ml 的患者中，也发现了 PSMA 阳性病变。
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