澳大利亚在前列腺癌的原发诊断和局部治疗后生化复发时的分期中使用 Tc-PSMA SPECT/CT 的经验。

An Australian experience using Tc-PSMA SPECT/CT in the primary diagnosis of prostate cancer and for staging at biochemical recurrence after local therapy.

机构信息

Garran Medical Imaging, Garran, Australian Capital Territory, Australia.

University of Canberra, Canberra, Australian Capital Territory, Australia.

出版信息

Prostate. 2023 Jul;83(10):970-979. doi: 10.1002/pros.24538. Epub 2023 Apr 12.

DOI:10.1002/pros.24538

PMID:37051636

Abstract

BACKGROUND

Technetium 99 prostate-specific membrane antigen (Tc-PSMA) single-photon emission computed tomography/computed tomography (SPECT/CT) has the potential to provide greater accessibility globally than gallium 68 (Ga)-PSMA positron emission tomography (PET)/CT but has not been studied as extensively in primary diagnosis, staging, or relapse of prostate cancer (PC). We instituted a novel SPECT/CT reconstruction algorithm using Tc-PSMA and established a database to prospectively accumulate data on all patients referred with PC. This study extracts data on all patients referred over a 3.5-year period with the primary aim of comparing the diagnostic accuracy of Tc-PSMA and multiparametric magnetic resonance imaging (mpMRI) in the primary diagnosis of PC. The secondary aim was to assess the sensitivity of Tc-PSMA in detecting disease with relapse after either radical prostatectomy or primary radiotherapy.

METHODS

A total of 425 men referred for primary staging (PS) of PC and 172 men referred with biochemical relapse (BCR) were evaluated. We evaluated diagnostic accuracy and correlations between Tc-PSMA SPECT/CT, magnetic resonance imaging (MRI), prostate biopsy, prostate-specific antigen (PSA), and age in the PS group and positivity rates at different PSA levels in the BCR group.

RESULTS

Taking the biopsy's grade according to the International Society of Urological Pathology protocol as a reference, the sensitivity (true positive rate), specificity (true negative rate), accuracy (positive and negative predictive value), and precision (positive predictive value) for Tc-PSMA in the PS group were 99.7%, 83.3%, 99.4%, and 99.7%, respectively. Comparison rates for MRI in this group were 96.4%, 71.4%, 95.7%, and 99.1%. We found moderate correlations between Tc-PSMA uptake in the prostate and biopsy grade, the presence of metastases, and PSA. In BCR, the Tc-PSMA positive rates were 38.9%, 53.2%, 62.5%, and 84.6% at PSA levels of <0.2, 0.2 to <0.5, 0.5 to <1.0, and > 1.0 ng/mL respectively.

CONCLUSIONS

We have shown that Tc-PSMA SPECT/CT using an enhanced reconstruction algorithm has a diagnostic performance similar to Ga-PSMA PET/CT and mpMRI in an everyday clinical setting. It may have some advantages in cost, sensitivity for primary lesion detection, and the ability for intraoperative localization of lymph nodes.

摘要

背景

锝 99 前列腺特异性膜抗原（Tc-PSMA）单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）在全球范围内具有比镓 68（Ga）-PSMA 正电子发射断层扫描（PET）/CT 更高的可及性，但在前列腺癌（PC）的初始诊断、分期或复发方面的研究还不够广泛。我们使用 Tc-PSMA 引入了一种新的 SPECT/CT 重建算法，并建立了一个数据库，前瞻性地积累所有转诊 PC 患者的数据。本研究提取了 3.5 年内所有转诊患者的数据，主要目的是比较 Tc-PSMA 和多参数磁共振成像（mpMRI）在 PC 初始诊断中的诊断准确性。次要目的是评估 Tc-PSMA 在检测根治性前列腺切除术或原发性放疗后复发疾病的敏感性。

方法

共评估了 425 名因 PC 初始分期（PS）而转诊的男性和 172 名因生化复发（BCR）而转诊的男性。我们评估了 Tc-PSMA SPECT/CT、磁共振成像（MRI）、前列腺活检、前列腺特异性抗原（PSA）和年龄在 PS 组中的诊断准确性以及 BCR 组中不同 PSA 水平的阳性率之间的相关性。

结果

以国际泌尿病理学会（ISUP）方案的活检分级为参考，Tc-PSMA 在 PS 组中的灵敏度（真阳性率）、特异性（真阴性率）、准确性（阳性和阴性预测值）和精密度（阳性预测值）分别为 99.7%、83.3%、99.4%和 99.7%。该组中 MRI 的比较率分别为 96.4%、71.4%、95.7%和 99.1%。我们发现 Tc-PSMA 在前列腺中的摄取与活检分级、转移存在和 PSA 之间存在中度相关性。在 BCR 中，Tc-PSMA 的阳性率分别为 38.9%、53.2%、62.5%和 84.6%，PSA 水平分别为<0.2、0.2 至<0.5、0.5 至<1.0 和>1.0ng/ml。