Pacific Radiology, Christchurch, Canterbury, New Zealand.
Department of Medical Imaging, St. Vincent's Hospital, Melbourne, Vic., Australia.
BJU Int. 2022 Jun;130 Suppl 1(Suppl 1):28-36. doi: 10.1111/bju.15724.
To assess the correlation of pathological radical prostatectomy (RP) specimen features and prostate-specific antigen (PSA) characteristics to imaging findings on subsequent F-DCFPyL positron emission tomography/computed tomography (PET/CT) in patients with biochemical failure (BF).
Retrospective analysis of combined F-DCFPyL PET/CT database of patients from centres in Australia and New Zealand was performed. A total of 205 patients presenting with BF after RP were included in this study. Imaging findings on F-DCFPyL PET/CT were recorded and correlated with the PSA characteristics at BF and pathological features of the original tumour.
Of the 205 patients, 120 (58.5%) had evidence of abnormal prostate-specific membrane antigen (PSMA) expression compatible with recurrent prostate cancer. Increasing PSA velocity (P = 0.01), International Society of Urological Pathology (ISUP) Grade Group (P = 0.02), lymphovascular invasion (P = 0.05) and nodal positivity (P = 0.02) at the time of RP were more likely to demonstrate PSMA positivity. Multivariable logistic regression revealed a higher PSA level prior to PSMA PET/CT (P < 0.01), adjuvant radiotherapy (P = 0.09), Gleason score ≥8 (P < 0.01) and nodal positivity (P = 0.05) were all predictive of PSMA positivity.
F-DCFPyL PET/CT positivity, both generally and site specific, correlates with PSA and RP pathological factors. Our results echo cohorts focussing on post-RP patients, those imaged with Ga-PSMA and those concerning biochemical persistence. Nomograms that include risk factors for 'PSMA-positive recurrence' in the BF population may increase the catchment of patients with disease confined to the prostate bed or pelvis who have a greater probability of prolonged disease-free survival.
评估生化复发（BF）患者前列腺特异性抗原（PSA）特征与病理根治性前列腺切除术（RP）标本特征与后续 F-DCFPyL 正电子发射断层扫描/计算机断层扫描（PET/CT）影像学结果之间的相关性。
对来自澳大利亚和新西兰中心的 F-DCFPyL PET/CT 数据库进行回顾性分析。本研究共纳入 205 例 RP 后 BF 的患者。记录 F-DCFPyL PET/CT 的影像学结果，并将其与 BF 时 PSA 特征和原始肿瘤的病理特征相关联。
在 205 例患者中，120 例（58.5%）有证据表明前列腺特异性膜抗原（PSMA）表达异常，符合复发性前列腺癌。RP 时 PSA 速度增加（P=0.01）、国际泌尿病理学会（ISUP）分级组（P=0.02）、脉管侵犯（P=0.05）和淋巴结阳性（P=0.02）更有可能表现出 PSMA 阳性。多变量逻辑回归显示，PSMA-PET/CT 前 PSA 水平较高（P<0.01）、辅助放疗（P=0.09）、Gleason 评分≥8（P<0.01）和淋巴结阳性（P=0.05）均与 PSMA 阳性相关。
F-DCFPyL PET/CT 阳性，无论是普遍阳性还是特定部位阳性，都与 PSA 和 RP 病理因素相关。我们的结果与专注于 RP 后患者、Ga-PSMA 成像患者和关注生化持续存在患者的队列结果一致。在 BF 人群中包含“PSMA 阳性复发”危险因素的列线图可能会增加疾病局限于前列腺床或骨盆的患者的捕获率，这些患者有更长无病生存的可能性。
