Kim Dong-Yun, Lee Won Woo, Song Yoo Sung, Hong Sung Kyu, Byun Seok-Soo, Kim Jae-Sung
Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Prostate Int. 2023 Jun;11(2):69-75. doi: 10.1016/j.prnil.2022.11.001. Epub 2022 Nov 12.
The optimal condition for the clinical application of F-fluorocholine positron emission tomography-computed tomography (FCH-PET/CT) to detect recurrence sites in prostate-specific antigen (PSA) failure remains unclear due to the heterogeneity of prostate cancer failure. We aimed to evaluate the detection rate of FCH-PET/CT in prostate cancer patients with PSA failure and to determine the optimal PSA level for performing FCH-PET/CT.
FCH-PET/CT was conducted in 89 patients diagnosed with PSA failure after radical treatment (radical prostatectomy in 75 and definitive radiotherapy in 14) between November 2018 and May 2021. Detection rates were examined via receiver operating characteristic (ROC) analysis, and multivariable logistic regression was performed to identify factors affecting positive FCH-PET/CT findings. We also conducted subgroup analyses according to the PSA failure patterns after the radical treatment (persistently high PSA [ = 48] and biochemical recurrence [BCR] [ = 41]).
FCH-PET/CT demonstrated a 59.6% overall detection rate, and the optimal PSA threshold for detecting positive findings was ≥ 1.00 ng/mL at the time of imaging. On multivariable analysis, PSA > 1.00 ng/mL ( < 0.001) was a significant predictor of positive FCH-PET/CT findings, especially regarding distant bone metastases ( < 0.001) and recurrence outside the pelvis ( < 0.001). In a subgroup analysis of patients with BCR after initial radical treatment, the area under the ROC curve (AUC) was 0.82, and PSA ≥ 1.75 ng/mL was the optimal value for identifying positive FCH-PET/CT findings. This PSA value was also associated with significantly higher detection rates of distant bone metastases and outside-pelvis metastasis ( < 0.001, both).
FCH-PET/CT is a clinically useful tool for detecting tumor recurrence sites in prostate cancer patients with PSA failure if PSA has exceeded a certain value at the time of imaging. Particularly, higher AUC values were observed when FCH-PET/CT was performed in patients with BCR after initial treatment.
由于前列腺癌复发情况的异质性，¹⁸F-氟胆碱正电子发射断层扫描-计算机断层扫描（FCH-PET/CT）在检测前列腺特异性抗原（PSA）失败患者复发部位的临床应用中的最佳条件尚不清楚。我们旨在评估FCH-PET/CT在PSA失败的前列腺癌患者中的检测率，并确定进行FCH-PET/CT的最佳PSA水平。
2018年11月至2021年5月期间，对89例根治性治疗后诊断为PSA失败的患者进行了FCH-PET/CT检查（75例行根治性前列腺切除术，14例行根治性放疗）。通过受试者操作特征（ROC）分析检查检测率，并进行多变量逻辑回归以确定影响FCH-PET/CT阳性结果的因素。我们还根据根治性治疗后的PSA失败模式进行了亚组分析（持续高PSA [n = 48]和生化复发[BCR] [n = 41]）。
FCH-PET/CT的总体检测率为59.6%，成像时检测阳性结果的最佳PSA阈值为≥1.00 ng/mL。在多变量分析中，PSA>1.00 ng/mL（P<0.001）是FCH-PET/CT阳性结果的重要预测因素，尤其是远处骨转移（P<0.001）和盆腔外复发（P<0.001）。在初始根治性治疗后发生BCR的患者亚组分析中，ROC曲线下面积（AUC）为0.82，PSA≥1.75 ng/mL是识别FCH-PET/CT阳性结果的最佳值。该PSA值也与远处骨转移和盆腔外转移的检测率显著更高相关（两者均P<0.001）。
如果成像时PSA超过一定值，FCH-PET/CT是检测PSA失败的前列腺癌患者肿瘤复发部位的临床有用工具。特别是，在初始治疗后发生BCR的患者中进行FCH-PET/CT检查时观察到更高的AUC值。
