Department of Urology, Amsterdam University Medical Center, VU University, Amsterdam, the Netherlands.
Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center, VU University, Amsterdam, the Netherlands.
BJU Int. 2022 Jun;129(6):768-776. doi: 10.1111/bju.15710. Epub 2022 Mar 12.
To investigate the association between intraprostatic, intratumoral maximum standardised uptake values (SUV ) on prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in patients with prostate cancer (PCa) prior to robot-assisted radical prostatectomy (RARP) and pathology outcomes, including pathological International Society of Urological Pathology score (pISUP) and lymph node (LN) status (pN0/pN1).
A bi-centric, secondary analysis of two previous, prospective cohort studies was performed in 318 patients with biopsy confirmed PCa and who were scheduled for RARP. Before surgery, patients received a PSMA PET/CT with either Ga-PSMA-11 (59% of the patients) or F-PSMA (DCFPyL; 41%) as radiotracer. PET/CT images were analysed both visually and semi-quantitatively by measuring the SUV of the most intense suspect lesion in the prostate. The association between the SUV of the primary tumour and pre- and postoperative variables was analysed.
The SUV was associated with clinical and biopsy preoperative variables, as well as with pISUP score and pathological tumour stage. Patients with a pISUP of ≤2 showed significantly lower SUV compared to patients with a pISUP of >2 for both tracers (SUV F-PSMA: median 5.1 vs 9.6, P = 0.002; SUV Ga-PSMA-11: 6.6 vs 8.6, P = 0.003). Moreover, patients with pN1 had significantly higher median SUV than those with pN0/pNx for both tracers (SUV F-PSMA: 7.9 vs 12.3, P = 0.04; SUV Ga-PSMA-11: 7.6 vs 12.0, P < 0.001). On multivariable logistic regression analysis, the intraprostatic SUV was an independent predictor of pN1 for both Ga-PSMA-11 (per doubling: odds ratio [OR] 1.96, 95% confidence interval [CI] 1.27-3.01)) and F-PSMA (per doubling: OR 1.79, 95% CI 1.06-3.03).
Intraprostatic, intratumoral PSMA intensity on PET/CT, as semi-quantitatively expressed by SUV , may be a valuable innovative biomarker in patients with localised PCa, as it is highly associated with known conventional prognostic factors, such as pISUP and LN status.
探讨前列腺特异性膜抗原（PSMA）正电子发射断层扫描/计算机断层扫描（PET/CT）在机器人辅助根治性前列腺切除术（RARP）前前列腺癌（PCa）患者中前列腺内、肿瘤内最大标准化摄取值（SUV）与病理结果的相关性，包括病理国际泌尿病理学会评分（pISUP）和淋巴结（LN）状态（pN0/pN1）。
对 318 例经活检证实患有 PCa 并计划接受 RARP 的患者进行了两项先前前瞻性队列研究的双中心二次分析。手术前，患者接受了 Ga-PSMA-11（59%的患者）或 F-PSMA（DCFPyL；41%）作为放射性示踪剂的 PSMA PET/CT。通过测量前列腺中最强烈可疑病变的 SUV ，对 PET/CT 图像进行了视觉和半定量分析。分析了 SUV 与术前临床和活检变量以及 pISUP 评分和病理肿瘤分期之间的相关性。
SUV 与临床和活检术前变量以及 pISUP 评分和病理肿瘤分期相关。pISUP 评分≤2 的患者与 pISUP 评分>2 的患者相比，两种示踪剂的 SUV 均显著降低（SUV F-PSMA：中位数 5.1 比 9.6，P=0.002；SUV Ga-PSMA-11：6.6 比 8.6，P=0.003）。此外，对于两种示踪剂，pN1 患者的 SUV 中位数均显著高于 pN0/pNx 患者（SUV F-PSMA：7.9 比 12.3，P=0.04；SUV Ga-PSMA-11：7.6 比 12.0，P<0.001）。多变量逻辑回归分析显示，对于 Ga-PSMA-11（每翻倍：优势比 [OR] 1.96，95%置信区间 [CI] 1.27-3.01）和 F-PSMA（每翻倍：OR 1.79，95% CI 1.06-3.03），前列腺内 SUV 是 pN1 的独立预测因子。
PET/CT 上前列腺内、肿瘤内 PSMA 强度（以 SUV 表示的半定量表达）可能是局部 PCa 患者有价值的创新生物标志物，因为它与已知的传统预后因素高度相关，如 pISUP 和 LN 状态。
