Duan Heying, Iagaru Andrei
Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA.
Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA.
Semin Nucl Med. 2024 Jan;54(1):77-86. doi: 10.1053/j.semnuclmed.2023.07.002. Epub 2023 Aug 9.
Prostate cancer (PC) is a significant health concern worldwide, with high incidence and mortality rates. Early and accurate detection and localization of recurrent disease at biochemical recurrence (BCR) is critical for guiding subsequent therapeutic decisions and improving patient outcomes. At BCR, conventional imaging consisting of CT, MRI, and bone scintigraphy are recommended by US and European guidelines, however, these modalities all bear certain limitations in detecting metastatic disease, particularly in low-volume relapse at low prostate-specific antigen (PSA) levels. Molecular imaging with PET/CT or PET/MRI using prostate-specific membrane antigen (PSMA) targeting radiopharmaceuticals has revolutionized imaging of PC. Particularly at BCR PC, PSMA PET has shown better diagnostic performance compared to conventional imaging in detecting local relapse and metastases, even at very low PSA levels. The most recent version of the National Comprehensive Cancer Network (NCCN) guideline has included PSMA-targeted PET/CT or PET/MRI for the localization of BCR PC. There are several different PSMA-targeting radiopharmaceuticals labeled with different radioisotopes, each with slightly different characteristics, but overall similar high sensitivity and specificity for PC. PSMA-targeted PET has the potential to significantly impact patient care by guiding personalized treatment decisions and thus improving outcomes in BCR PC patients.
前列腺癌（PC）是全球范围内一个重大的健康问题，其发病率和死亡率都很高。在生化复发（BCR）时对复发性疾病进行早期、准确的检测和定位，对于指导后续治疗决策和改善患者预后至关重要。在美国和欧洲的指南中，BCR时推荐采用包括CT、MRI和骨闪烁显像在内的传统成像方法，然而，这些方法在检测转移性疾病方面都存在一定局限性，尤其是在低前列腺特异性抗原（PSA）水平下的低容量复发情况。使用靶向前列腺特异性膜抗原（PSMA）的放射性药物进行PET/CT或PET/MRI分子成像，彻底改变了PC的成像方式。特别是在BCR PC中，与传统成像相比，PSMA PET在检测局部复发和转移方面，即使在非常低的PSA水平下，也显示出更好的诊断性能。美国国立综合癌症网络（NCCN）指南的最新版本已将PSMA靶向PET/CT或PET/MRI纳入BCR PC的定位检查中。有几种不同的靶向PSMA的放射性药物，它们标记着不同的放射性同位素，每种药物的特性略有不同，但总体上对PC具有相似的高灵敏度和特异性。PSMA靶向PET有潜力通过指导个性化治疗决策，从而显著影响患者护理，并改善BCR PC患者的预后。
