Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands;
Department of Urology, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands.
J Nucl Med. 2023 Aug;64(8):1238-1243. doi: 10.2967/jnumed.122.265205. Epub 2023 Jun 29.
Our objective was to determine the diagnostic value of prostate-specific membrane antigen (PSMA) PET/CT in staging men with newly diagnosed unfavorable intermediate-risk prostate cancer (PCa). Patients with newly diagnosed unfavorable intermediate-risk PCa, in whom PSMA PET/CT was performed as a primary staging modality, were retrospectively studied. PSMA PET/CT was performed at several diagnostic centers and reported by expert nuclear medicine physicians within 2 high-volume PCa centers. A multivariate logistic regression analysis, taking into account clinical, biochemical, pathologic, and radiologic variables, was performed to identify potential independent predictors for metastatic disease on PSMA PET/CT. In total, 396 men with newly diagnosed unfavorable intermediate-risk PCa were studied. Metastatic disease was observed in 37 (9.3%) men, of whom 29 (7.3%) had molecular imaging locoregional lymph node metastases (miN1) and 16 (4.0%) had distant metastases (miM1). A radiologic tumor stage of at least T3 on MRI (odds ratio, 2.72 [95% CI, 1.27-5.83]; = 0.01) and more than 50% positive prostate biopsies (odds ratio, 3.87 [95% CI, 1.74-8.62]; = 0.001) were found to be independently associated with metastatic disease on PSMA PET/CT. Given that metastatic disease was observed in nearly 1 in 10 men with newly diagnosed unfavorable intermediate-risk PCa, PSMA PET/CT is considered to be of diagnostic value within this population. Further stratification using the radiologic tumor stage and the percentage of positive prostate biopsies could aid in identifying those patients at risk of having metastatic disease on PSMA PET/CT.
我们的目的是确定前列腺特异性膜抗原（PSMA）PET/CT 在诊断新诊断为不利中危前列腺癌（PCa）的男性中的诊断价值。回顾性研究了新诊断为不利中危 PCa 的患者，这些患者将 PSMA PET/CT 作为主要分期方式进行检查。PSMA PET/CT 在多个诊断中心进行，并由 2 个高容量 PCa 中心的核医学专家报告。采用多变量逻辑回归分析，考虑临床、生化、病理和影像学变量，以确定 PSMA PET/CT 上转移性疾病的潜在独立预测因素。共有 396 名新诊断为不利中危 PCa 的男性接受了研究。37 名（9.3%）男性观察到转移性疾病，其中 29 名（7.3%）有分子影像学局部淋巴结转移（miN1），16 名（4.0%）有远处转移（miM1）。MRI 上的至少 T3 期肿瘤分期（优势比，2.72[95%CI，1.27-5.83]； = 0.01）和超过 50%的阳性前列腺活检（优势比，3.87[95%CI，1.74-8.62]； = 0.001）被发现与 PSMA PET/CT 上的转移性疾病独立相关。鉴于新诊断为不利中危 PCa 的男性中近 10 分之一的患者观察到转移性疾病，因此 PSMA PET/CT 被认为在该人群中具有诊断价值。进一步使用影像学肿瘤分期和阳性前列腺活检的百分比进行分层，可以帮助识别那些在 PSMA PET/CT 上有转移性疾病风险的患者。
