PSMA-11 PET/CT用于检测胆碱PET/CT结果为阴性的前列腺癌复发患者

PSMA-11 PET/CT for Detection of Recurrent Prostate Cancer in Patients With Negative Choline PET/CT.

作者信息

Pinot Fanny, Le Pennec Romain, Abgral Ronan, Blanc-Béguin Frédérique, Hennebicq Simon, Schick Ulrike, Valeri Antoine, Fournier Georges, Le Roux Pierre-Yves, Salaun Pierre-Yves, Robin Philippe

机构信息

Département de Médecine Nucléaire, Centre Hospitalier Universitaire de Brest, Brest, France.

Département de Médecine Nucléaire, Centre Hospitalier Universitaire de Brest, Brest, France; Inserm, Univ Brest, CHU Brest, UMR 1304, GETBO, Brest, France.

出版信息

Clin Genitourin Cancer. 2023 Apr;21(2):248-257. doi: 10.1016/j.clgc.2022.12.007. Epub 2022 Dec 28.

DOI:10.1016/j.clgc.2022.12.007

PMID:36658064

Abstract

INTRODUCTION

Prostate adenocarcinoma (CaP) is the leading cancer in men. After curative treatment, from 27% to 53% of patients will experience biochemical recurrence (BR). With the development of focal therapies, precise early identification of recurrence's sites is of utmost importance in order to deliver individualized treatment on positive lesions. The aim of this study was to assess the detection rate (DR) of Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) in selected patients with prostate cancer BR and recent negative F-choline PET/CT.

PATIENTS AND METHODS

We performed a retrospective analysis including all patients with CaP referred for BR with a negative F-choline PET/CT, and who underwent Ga-PSMA-11 PET/CT between October, 2018 and December, 2019. The overall DR of Ga-PSMA-11 PET/CT was calculated, and described according to BR characteristics especially PSA levels and velocity. Patients were followed up for at least 1 year. Patient management following Ga-PSMA-11 PET/CT and PSA levels evolution after treatment were also recorded.

RESULTS

One hundred fifty-nine patients comprising 164 examinations were analyzed. The overall DR of Ga-PSMA-11 PET/CT for BR was 65.9% (95CI, 58.6-73.1). The DR was 52.5% (95CI, 39.9-65.0), 70.6% (95CI, 55.3-85.9), 70.4% (95CI, 53.1-87.6), and 78.6% (95CI, 66.2-91.0) for PSA levels between 0.2 and 0.49 ng/mL, 0.5 to 0.99 ng/mL, 1 to 1.99 ng/mL and PSA ≥ 2 ng/mL, respectively. The DR was 70.7% (95CI, 59.0-82.4) with a PSA doubling time (PSA-DT) ≤6 months and 65.2% (95CI, 55.5-74.9) with a PSA-DT >6 months. Around 3/4 of patients (75.9%) with a positive Ga-PSMA-11 PET/CT initiated treatment, including surgery (2.4%), stereotactic radiotherapy ± androgen deprivation therapy (ADT) (22%) or external conformational radiotherapy ± ADT (46.3%). Patient management changed in 43 cases (39.8%).

CONCLUSION

Our study confirmed the ability of Ga-PSMA-11 PET/CT to detect occult biochemical recurrence, even in a selected population of CaP patients with negative F-choline PET/CT, even at low PSA levels.

摘要

引言

前列腺腺癌（CaP）是男性中最常见的癌症。在进行根治性治疗后，27%至53%的患者会出现生化复发（BR）。随着局部治疗的发展，准确早期识别复发部位对于对阳性病变进行个体化治疗至关重要。本研究的目的是评估镓-PSMA-11正电子发射断层扫描/计算机断层扫描（PET/CT）在选定的前列腺癌BR且近期F-胆碱PET/CT结果为阴性的患者中的检出率（DR）。

患者与方法

我们进行了一项回顾性分析，纳入了所有因BR而接受检查且F-胆碱PET/CT结果为阴性的CaP患者，这些患者在2018年10月至2019年12月期间接受了镓-PSMA-11 PET/CT检查。计算了镓-PSMA-11 PET/CT的总体DR，并根据BR特征尤其是前列腺特异性抗原（PSA）水平和速度进行描述。对患者进行了至少1年的随访。还记录了镓-PSMA-11 PET/CT检查后的患者管理情况以及治疗后PSA水平的变化。

结果

分析了159例患者的164次检查。镓-PSMA-11 PET/CT对BR的总体DR为65.9%（95%置信区间，58.6 - 73.1）。PSA水平在0.2至0.49 ng/mL、0.5至0.99 ng/mL、1至1.99 ng/mL和PSA≥2 ng/mL时，DR分别为52.5%（95%置信区间，39.9 - 65.0）、70.6%（95%置信区间，55.3 - 85.9）、70.4%（95%置信区间，53.1 - 87.6）和78.6%（95%置信区间，66.2 - 91.0）。PSA倍增时间（PSA-DT）≤6个月时DR为70.7%（95%置信区间，59.0 - 82.4），PSA-DT>6个月时DR为65.2%（95%置信区间，55.5 - 74.9）。镓-PSMA-11 PET/CT结果为阳性的患者中约3/4（75.9%）开始接受治疗，包括手术（2.4%）、立体定向放疗±雄激素剥夺治疗（ADT）（22%）或外照射适形放疗±ADT（46.3%）。43例（39.8%）患者的管理发生了变化。