68Ga-PSMA PET/CT 评估纳入前列腺癌主动监测的男性患者。

68Ga-PSMA PET/CT evaluation in men enrolled in prostate cancer Active Surveillance.

机构信息

Urology Unit, Cannizzaro Hospital, Catania.

Radiotherapy Unit, Cannizzaro Hospital, Catania.

出版信息

Arch Ital Urol Androl. 2023 May 22;95(2):11322. doi: 10.4081/aiua.2023.11322.

DOI:10.4081/aiua.2023.11322

PMID:37212907

Abstract

INTRODUCTION

To evaluate the accuracy of 68Ga-prostate specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in the diagnosis of clinically significant prostate cancer (csPCa: Grade Group ≥ 2) in men enrolled in Active Surveillance (AS) protocol.

MATERIALS AND METHODS

From May 2013 to December 2021 200 men aged between 52 and 74 years (median age 63) with very low risk PCa were enrolled in an AS protocol study. During the follow up 48/200 (24%) men were upgraded and 10/200 (5%) decided to leave the AS protocol. After five years from confirmatory biopsy (range: 48-60 months) 40/142 (28.2%) consecutive patients were submitted to mpMRI and 68Ga-PSMA PET/CT imaging examinations before scheduled repeated biopsy. All the mpMRI (PI-RADS ≥ 3) and 68Ga-PET/TC standardized uptake value (SUVmax) ≥ 5 index lesions underwent targeted cores (mpMRI-TPBx and PSMA-TPBx) combined with transperineal saturation prostate biopsy (SPBx: median 20 cores).

RESULTS

Multiparametric MRI and 68Ga-PSMA PET/CT showed 18/40 (45%) and 9/40 (22.5%) lesions suspicious for PCa. In 3/40 (7.5%) men a csPCa (GG2) was found; 68Ga-PSMA-TPBx vs. mpMRI-TPBx vs. SPBx diagnosed 2/3 (66.6%) vs. 2/3 (66.6%) vs. 3/3 (100%) csPCa, respectively. In detail, mpMRI and 68Ga-PSMA PET/TC demonstrated 16/40 (40%) vs. 7/40 (17.5%) false positive and 1 (33.3%) vs. 1 (33.3%) false negative results.

CONCLUSION

Although 68PSMA PET/CT did not improve the detection for csPCa of SPBx (1 false negative result equal to 33.3% of the cases), at the same time, would have spared 31/40 (77.5%) scheduled biopsies showing a better diagnostic accuracy in comparison with mpMRI (83.3% vs. 70.2%).

摘要

简介

评估 68Ga-前列腺特异膜抗原（PSMA）正电子发射断层扫描/计算机断层扫描（PET/CT）在接受主动监测（AS）方案的男性中诊断临床显著前列腺癌（csPCa：分级组≥2）的准确性。

材料和方法

2013 年 5 月至 2021 年 12 月，200 名年龄在 52 至 74 岁之间（中位年龄 63 岁）、前列腺癌风险极低的男性入组 AS 方案研究。在随访期间，48/200（24%）名男性升级，10/200（5%）名男性决定退出 AS 方案。在确认活检后五年（范围：48-60 个月），对 142 名连续患者中的 40 名（28.2%）进行了 mpMRI 和 68Ga-PSMA PET/CT 成像检查，然后进行计划重复活检。所有的 mpMRI（PI-RADS≥3）和 68Ga-PET/TC 标准摄取值（SUVmax）≥5 的病变均进行了靶向核心（mpMRI-TPBx 和 PSMA-TPBx）联合经会阴饱和前列腺活检（SPBx：中位数 20 个核心）。

结果

多参数 MRI 和 68Ga-PSMA PET/CT 显示 18/40（45%）和 9/40（22.5%）个病变可疑为前列腺癌。在 3/40（7.5%）名男性中发现了 csPCa（GG2）；68Ga-PSMA-TPBx 与 mpMRI-TPBx 与 SPBx 诊断出 2/3（66.6%）与 2/3（66.6%）与 3/3（100%）csPCa，分别。详细地，mpMRI 和 68Ga-PSMA PET/TC 显示出 16/40（40%）与 7/40（17.5%）的假阳性和 1（33.3%）与 1（33.3%）的假阴性结果。