Department of Nuclear Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1655, Kong Jiang Road, Yangpu District, Shanghai, 200092, China.
Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1655, Kong Jiang Road, Yangpu District, Shanghai, 200092, China.
Curr Radiopharm. 2024;17(4):382-397. doi: 10.2174/1874471016666230915103157.
This study aimed to evaluate the performance of 18F-MD-PSMA PET/CT in patients previously treated for prostate cancer by either surgery or therapy, but later relapsed biochemically.
This retrospective study enrolled 213 patients in sequence previously treated for prostate cancer by either surgery or therapy, but later PSA relapsed. A total of 191 of these 213 patients were included in this analysis. All patients were biochemically relapsed after radical prostatectomy or therapy, had 18F-MD-PSMA PET/CT scan within 1 week, and were off hormonal therapy at the time of the scans. The new tracer was compared directly with 11C-choline in sensitivity.
In 3 patients, a side-by-side comparison between 18F-MD-PSMA and 11C-choline was performed, and it was found that the former was about 3 times more sensitive than the latter. The analysis of PET imaging using 18F-MD-PSMA in 191 relapsed patients showed that less than 10% of patients showed the disease limited in the prostate. Among the remote lesions, the number in decreasing order was bone, followed by lymph nodes and other organs. The maximal SUV in lesions in each patient followed an exponential decay, with SUV inclined to the lower end. The Gleason score measured at the diagnosis showed no correlation with the average number of lesions in each patient, the average maximal SUV values among this cohort of patients, and the PSA values measured at the time of PET imaging. The number of lesions observed in each patient has no correlation with the PSA value measured at the time of PET imaging. When PSA value was measured as an independent biomarker at the time of PET imaging, the positivity of PET imaging using 18F-MD-PSMA increased along with an increase in PSA value, but with exceptions where PSMA expression was low or negative. From the PET imaging of this radioligand, the majority of patients showed oligo-metastasis, favoring using local therapy to manage the disease.
An 18F-MD-PSMA as a radioligand was found to be superior to 11C-choline in the setting of patients with biochemical relapse after previous treatment. Its PET imaging results matched those of established PSMA radioligands, but its chemical structure was found to have added features to conjugate with other functional molecules, such as those with therapeutic properties. This radioligand lays the foundation for our further work.
本研究旨在评估 18F-MD-PSMA PET/CT 在前列腺癌根治术后或局部治疗后生化复发的患者中的性能。
本回顾性研究连续纳入 213 例前列腺癌根治术后或局部治疗后生化复发的患者，其中 191 例纳入本分析。所有患者均在根治性前列腺切除术或治疗后生化复发，在 1 周内进行 18F-MD-PSMA PET/CT 扫描，且在扫描时均未接受激素治疗。新示踪剂与 11C-胆碱的敏感性进行了直接比较。
在 3 例患者中，对 18F-MD-PSMA 和 11C-胆碱进行了并排比较，发现前者比后者敏感约 3 倍。对 191 例复发患者的 18F-MD-PSMA PET 成像分析显示，不到 10%的患者显示疾病局限于前列腺。在远处病变中，按数量递减顺序依次为骨骼、淋巴结和其他器官。每位患者病变中的最大 SUV 呈指数衰减，SUV 倾向于低值端。诊断时的 Gleason 评分与每位患者的平均病变数、该队列患者的平均最大 SUV 值以及 PET 成像时测量的 PSA 值均无相关性。每位患者观察到的病变数量与 PET 成像时测量的 PSA 值无关。当 PSA 值作为 PET 成像时的独立生物标志物测量时，使用 18F-MD-PSMA 的 PET 成像阳性率随 PSA 值的升高而升高，但也存在 PSMA 表达低或阴性的例外情况。从该放射性配体的 PET 成像来看，大多数患者表现为寡转移，有利于采用局部治疗来控制疾病。
在先前治疗后生化复发的患者中，18F-MD-PSMA 作为一种放射性配体，其性能优于 11C-胆碱。其 PET 成像结果与已建立的 PSMA 放射性配体相匹配，但发现其化学结构具有与其他功能分子（如具有治疗特性的分子）结合的附加特征。该放射性配体为我们的进一步工作奠定了基础。
