Kesler Mikhail, Kerzhner Kosta, Druckmann Ido, Kuten Jonathan, Levine Charles, Sarid David, Keizman Daniel, Yossepowitch Ofer, Even-Sapir Einat
Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.
Department of Radiology-Musculoskeletal Imaging Unit, Imaging Division, Tel Aviv Sourasky Medical Center, 6423906, Tel Aviv, Israel.
Eur J Nucl Med Mol Imaging. 2022 May;49(6):2077-2085. doi: 10.1007/s00259-021-05655-y. Epub 2021 Dec 27.
The aim of the study was to elaborate the incidence and type of skeletal involvement in a large cohort of patients with newly diagnosed prostate cancer (PCa) referred for Ga-68 PSMA-11 PET/CT staging in a single center.
Study cohort included 963 consecutive patients with newly diagnosed PCa referred for Ga-68 PSMA-11 PET/CT study for staging. The incidence of bone involvement, type of bone metastases, and extent of disease were determined and correlated with the ISUP Grade Group (GG) criteria and PSA levels.
Bone metastases were found in 188 (19.5%) of 963 patients. Bone metastases were found in 10.7% of patients with PSA < 10 ng/dL and in 27.4% of patients with PSA > 10 ng/dL and in 6.1% of patients with GG ≤ 2/3 and in 8.9% of patients with GG 4/5. In 7.6% of the patients, skeletal involvement was extensive, while 11.9% of patients had oligometastatic disease. Osteoblastic type metastases were the most common type of bone metastases presented in 133 of the patients with malignant bone involvement (70.7%). More than half of them had only osteoblastic lesions (72 patients (38.3%)), while the other (61 patients (32.5%)) had also intramedullary and/or osteolytic type lesions. Intramedullary metastases were found in 97 patients (51.6%), while 41 (21.8%) of them were only intramedullary lesions. Osteolytic metastases were detected in 36 patients (19.2%), of which 8 were only osteolytic lesions.
Although traditionally bone metastases of PCa are considered osteoblastic, osteolytic and intramedullary metastases are common, as identified on PET with labeled PSMA. Skeletal spread may be present also in patients with GG ≤ 2/3 and PSA < 10 ng/dL.
本研究旨在阐述在单一中心接受Ga-68 PSMA-11 PET/CT分期的一大群新诊断前列腺癌（PCa）患者中骨骼受累的发生率及类型。
研究队列包括963例连续的新诊断PCa患者，他们因分期接受Ga-68 PSMA-11 PET/CT检查。确定骨受累的发生率、骨转移类型及疾病范围，并与国际泌尿病理学会（ISUP）分级组（GG）标准和前列腺特异性抗原（PSA）水平相关联。
963例患者中有188例（19.5%）发现骨转移。PSA＜10 ng/dL的患者中骨转移发生率为10.7%，PSA＞10 ng/dL的患者中为27.4%；GG≤2/3的患者中为6.1%，GG 4/5的患者中为8.9%。7.6%的患者骨骼受累广泛，11.9%的患者有寡转移疾病。成骨型转移是骨转移最常见的类型，在133例有恶性骨受累的患者中出现（70.7%）。其中一半以上仅有成骨病变（72例患者（38.3%）），而其他患者（61例患者（32.5%））也有髓内和/或溶骨型病变。97例患者（51.6%）发现髓内转移，其中41例（21.8%）仅为髓内病变。36例患者（19.2%）检测到溶骨型转移，其中8例仅为溶骨病变。
尽管传统上认为PCa的骨转移为成骨型，但如在标记PSMA的PET上所确定的，溶骨型和髓内转移也很常见。GG≤2/3且PSA＜10 ng/dL的患者也可能出现骨骼转移。
