Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey.
Department of Nuclear Medicine, Akdeniz University School of Medicine, Antalya, Turkey.
Urol Int. 2024;108(1):65-72. doi: 10.1159/000535466. Epub 2023 Nov 28.
The purpose of our study was to evaluate reliability of 68Ga-labeled prostate-specific membrane antigen positron emission tomography (68Ga-PSMA PET/CT) and identify appropriate SUVmax cutoff values in order to use for diagnosis, especially in patients remained clinically suspicious for prostate cancer (PCa).
Eighty-four patients applied 68Ga-PSMA PET/CT subsequent to transrectal ultrasound-guided prostate biopsy (TRUS-bx) involved in this study retrospectively. 68Ga-PSMA PET/CT imagings were analyzed by a nuclear medicine physician, and region of interests were drawn manually in prostate diagrams including 6 segments for each patient. These marked diagrams were analyzed with histopathology reports TRUS-bx. 504 segments were grouped with Gleason scoring system, and all groups were compared with mean SUVmax values.
Mean SUVmax value of Gleason grade group 1 (GG1, n: 352 segments) was 6.6 (±4.6) and significantly lower than the other groups (p < 0.001). No significant difference was detected within GG2-5 groups (p > 0.05). According to receiver operating characteristic curve analysis, SUVmax cutoff values were 1.0 (AUC: 0.961) for tumor detection, yielding a sensitivity, specificity, positive predictive value, negative predictive value of 99.4%, 92.1%, 96.5%, 98%, respectively, and 4.2 (AUC: 0.853) for detection of clinically significant PCa with 88.8%, 62.4%, 84.5%, and 71%, respectively. Although tumor percentage of biopsy core and Gleason group were correlated with SUVmax uptake, but patient age was not.
68Ga-PSMA PET appears to be a reliable option for diagnosis and disease management in PCa and can be considered especially in discrimination of csPCa, and patients remained suspicious for disease.
我们研究的目的是评估 68Ga 标记的前列腺特异性膜抗原正电子发射断层扫描（68Ga-PSMA PET/CT）的可靠性，并确定合适的 SUVmax 截断值，以便用于诊断，特别是在临床怀疑前列腺癌（PCa）的患者中。
回顾性分析了 84 例接受经直肠超声引导前列腺活检（TRUS-bx）后行 68Ga-PSMA PET/CT 的患者。核医学医师对 68Ga-PSMA PET/CT 图像进行分析，并手动在包括每位患者 6 个节段的前列腺图中绘制感兴趣区。这些标记的图与 TRUS-bx 的组织病理学报告进行分析。根据 Gleason 评分系统对 504 个节段进行分组，并比较各组的平均 SUVmax 值。
Gleason 分级 1 组（GG1，n=352 个节段）的平均 SUVmax 值为 6.6（±4.6），明显低于其他组（p < 0.001）。GG2-5 组之间无显著差异（p > 0.05）。根据受试者工作特征曲线分析，SUVmax 截断值为 1.0（AUC：0.961）用于肿瘤检测，灵敏度、特异性、阳性预测值、阴性预测值分别为 99.4%、92.1%、96.5%、98%，SUVmax 截断值为 4.2（AUC：0.853）用于检测有临床意义的 PCa，灵敏度、特异性、阳性预测值、阴性预测值分别为 88.8%、62.4%、84.5%、71%。尽管活检核心的肿瘤百分比和 Gleason 分组与 SUVmax 摄取相关，但患者年龄与 SUVmax 摄取无关。
68Ga-PSMA PET 似乎是诊断和管理 PCa 的可靠选择，尤其是在鉴别 csPCa 和对疾病有怀疑的患者时，可以考虑使用。
