Department of Nuclear Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134. Dongjie Street, Fuzhou, 350001, China.
Department of Urology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, China.
Sci Rep. 2022 Sep 26;12(1):15993. doi: 10.1038/s41598-022-20280-x.
The most common site of metastasis of prostate cancer (PCa) is bone. Skeletal-related events can increase the risk of death in patients with PCa by 28%. Due to the low detection rate of lesions in patients with low prostate-specific antigen (PSA) levels, the value of Tc methylene diphosphonate (Tc-MDP) bone scintigraphy is limited. Prostate-specific membrane antigen (PSMA) is a small molecular probe that can efficiently and specifically detect PCa lesions. This prospective study aimed to evaluate the difference between Tc-PSMA single-photon emission computed tomography (SPECT)/CT and Tc-MDP SPECT/CT in the detection of bone metastasis in PCa. A total of 74 men with pathologically confirmed PCa from October 2019 to November 2021 were prospectively enrolled in this study. The median age was 70 (range, 55-87) years. All patients underwent both Tc-PSMA SPECT/CT and Tc-MDP SPECT/CT at an average interval of 12.1 (range, 1-14) days. The detected imaging-positive bone lesions were scored as "typical metastasis" or "equivocal metastasis" by a standard reporting schema. Subsequent therapy modality details were observed through follow-up. Twenty-five of the 74 patients were diagnosed with bone metastases. Tc-PSMA SPECT/CT and Tc-MDP SPECT/CT detected 20 and 18 bone metastases, with sensitivities of 80.0% (20/25) and 72.0% (18/25), specificities of 100.0% (49/49) and 81.3% (40/49), and AUCs of 88.0% and 84.9%, respectively. There was a significant difference in the AUC between the two imaging methods (P < 0.001). In an analysis of the number of bone metastasis lesions, the proportion of "typical metastasis" versus "equivocal metastasis" detected by the two imaging methods was 26.3:1 (PSMA) and 2.9:1 (MDP), and the difference was statistically significant (P = 0.005). There was a significant difference in the detection of bone metastatic lesions by Tc-PSMA and Tc-MDP when the maximum diameter of the lesions was ≤ 0.6 cm (P < 0.05). The optimal cut-off value for PSA was 2.635 ng/mL (PSMA) and 15.275 ng/mL (MDP). Tc-PSMA SPECT/CT led to a change in management to a more individualized therapy modality for 11 of 74 men (14.9%). Tc-PSMA SPECT/CT was superior to Tc-MDP SPECT/CT in the detection of bone metastases in PCa, especially for small lesions and in patients with low PSA levels, and demonstrated an additional benefit of providing information on extraskeletal metastases. With regard to therapy, Tc-PSMA scans might have utility in improving the subsequent therapy modality.
前列腺癌（PCa）最常见的转移部位是骨骼。骨骼相关事件可使 PSA 水平低的 PCa 患者的死亡风险增加 28%。由于低 PSA 水平患者的病变检出率低，Tc 亚甲基二膦酸盐（Tc-MDP）骨闪烁显像的价值有限。前列腺特异性膜抗原（PSMA）是一种小分子探针，可有效且特异性地检测 PCa 病变。这项前瞻性研究旨在评估 PSMA 单光子发射计算机断层扫描（SPECT）/CT 与 MDP SPECT/CT 在检测 PCa 骨转移中的差异。2019 年 10 月至 2021 年 11 月，共纳入 74 例经病理证实的 PCa 患者，中位年龄为 70 岁（范围 55-87 岁）。所有患者平均间隔 12.1 天（范围 1-14 天）先后接受 Tc-PSMA SPECT/CT 和 Tc-MDP SPECT/CT 检查。采用标准报告方案将检测到的阳性骨病变评分“典型转移”或“疑似转移”。通过随访观察后续治疗方式的细节。74 例患者中，25 例诊断为骨转移。Tc-PSMA SPECT/CT 和 Tc-MDP SPECT/CT 分别检测到 20 处和 18 处骨转移，其灵敏度分别为 80.0%（20/25）和 72.0%（18/25），特异性分别为 100.0%（49/49）和 81.3%（40/49），曲线下面积分别为 88.0%和 84.9%。两种成像方法的 AUC 差异有统计学意义（P<0.001）。在对骨转移病变数量的分析中，两种成像方法检测到的“典型转移”与“疑似转移”的比例分别为 26.3:1（PSMA）和 2.9:1（MDP），差异有统计学意义（P=0.005）。当病变最大直径≤0.6cm 时，Tc-PSMA 和 Tc-MDP 检测骨转移病变的差异有统计学意义（P<0.05）。PSA 的最佳截断值为 2.635ng/mL（PSMA）和 15.275ng/mL（MDP）。Tc-PSMA SPECT/CT 使 74 例患者中的 11 例（14.9%）的管理发生了改变，采用了更个体化的治疗方式。Tc-PSMA SPECT/CT 对 PCa 骨转移的检测优于 Tc-MDP SPECT/CT，尤其是对小病变和 PSA 水平低的患者，并且还提供了有关骨骼外转移的额外信息。关于治疗，Tc-PSMA 扫描可能有助于改善后续的治疗方式。
