Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Nuclear Medicine, University Hospital Essen, Germany.
Rofo. 2023 Nov;195(11):1001-1008. doi: 10.1055/a-2088-9543. Epub 2023 Jun 22.
Prostate cancer (PCa) is the most common malignancy in men and the second most common tumor-associated cause of death in the male population in Germany. Prostate-specific membrane antigen (PSMA)-targeted hybrid imaging using positron emission tomography (PET) in combination with CT or MRI represents a comparably new method that gained increasing importance in the diagnostic process of PCa in recent years.
Current applications of PSMA hybrid imaging were summarized according to the German and European guidelines on PCa. New developments were elaborated based on a literature review of PubMed conducted in 10/22.
PSMA-PET/CT demonstrated higher detection rates for metastases in high-risk PCa and recurrent PCa after primary therapy than established imaging methods (CT, MRI, and bone scan). Despite promising results from prospective trials in both scenarios and substantial influence on clinical decision making, data regarding the influence of PSMA-PET on PCa-specific and overall survival are still lacking. Hence, PSMA PET/CT is recommended with a "weak" strength rating in most situations. However, its importance in new treatment options like metastasis-directed therapy or PSMA-radioligand therapy expands the scope of PSMA-PET in the clinical routine.
PSMA-targeting hybrid imaging represents the most sensitive diagnostic test in several stages of PCa and allows the development of new treatment strategies. Prospective studies are needed to evaluate the influence of PSMA-PET on patient survival.
· PSMA-PET/CT is superior to conventional imaging in the primary staging of high-risk prostate cancer.. · PSMA hybrid imaging can detect metastases in patients with biochemical recurrence at low PSA values.. · Clinical decision making is frequently influenced by results of PSMA-PET/CT..
· Koehler D, Berliner C, Shenas F et al. PSMA hybrid imaging in prostate cancer - current applications and perspectives. Fortschr Röntgenstr 2023; 195: 1001 - 1008.
前列腺癌（PCa）是男性中最常见的恶性肿瘤，也是德国男性人群中肿瘤相关死亡的第二大常见原因。使用正电子发射断层扫描（PET）与 CT 或 MRI 相结合的前列腺特异性膜抗原（PSMA）靶向混合成像代表了一种相对较新的方法，近年来在 PCa 的诊断过程中变得越来越重要。
根据德国和欧洲 PCa 指南总结了 PSMA 混合成像的当前应用。根据 10 月 22 日在 PubMed 上进行的文献综述阐述了新的发展。
与传统成像方法（CT、MRI 和骨扫描）相比，PSMA-PET/CT 对高危 PCa 转移和原发治疗后复发性 PCa 的检测率更高。尽管在这两种情况下前瞻性试验都有很有前景的结果，并对临床决策产生了实质性影响，但仍缺乏 PSMA-PET 对 PCa 特异性和总体生存率影响的数据。因此，PSMA-PET/CT 在大多数情况下都被推荐具有“弱”强度评分。然而，在转移定向治疗或 PSMA 放射性配体治疗等新治疗方案中的重要性扩展了 PSMA-PET 在临床常规中的范围。
PSMA 靶向混合成像代表了 PCa 几个阶段中最敏感的诊断测试，并且允许制定新的治疗策略。需要前瞻性研究来评估 PSMA-PET 对患者生存率的影响。
· PSMA-PET/CT 在高危前列腺癌的初始分期中优于传统成像。· PSMA 混合成像可以在 PSA 值较低的生化复发患者中检测转移。· PSMA-PET/CT 的结果经常影响临床决策。
