Xu Lian, Chen Ruohua, Yu Xiaofeng, Liu Jianjun, Wang Yuetao
Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China.
Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China.
Diagnostics (Basel). 2023 Dec 19;14(1):7. doi: 10.3390/diagnostics14010007.
Previous studies have indicated that F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) in biochemical recurrence (BCR) patients with poorly differentiated prostate adenocarcinoma had higher diagnostic sensitivity than those with well differentiated adenocarcinoma, but whether the performance of FDG PET can achieve the effect of prostate-specific membrane antigen (PSMA) PET in BCR patients with a high Gleason score remains poorly understood. This study aimed to compare the efficacies of F-FDG PET/CT and Ga-PSMA PET/CT for BCR patients and evaluate whether F-FDG PET was not inferior to Ga-PSMA PET for detecting BCR with a high Gleason score. This was a retrospective, head-to-head comparative study completed at Ren Ji Hospital between May 2018 and June 2021. Patients underwent both F-FDG and Ga-PSMA PET/CT. The detection rate of BCR at the patient level and at the anatomical region level was evaluated. In total, 145 patients were enrolled in this study. F-FDG PET/CT (24.1%, 35/145) had lower detection rates than Ga-PSMA PET/CT (59.3%, 86/145; < 0.001) at the patient level and at any anatomical region ( < 0.05). The PSA level ( < 0.001, OR = 11.026, 95% CI: 3.214-37.824) and the Gleason score ( < 0.001, OR = 20.227, 95% CI: 5.741-71.267) were independent predictive factors of the detection rate on F-FDG PET/CT, while the PSA level ( < 0.001, OR = 4.862, 95% CI: 2.338-10.110) was the only predictor of the detection rate on Ga-PSMA PET/CT. F-FDG PET/CT had a similar detection rate as Ga-PSMA PET/CT in patients with a Gleason score of 9 at the patient level (64.3% vs. 71.4%, = 0.567) and any anatomical region (all > 0.05), but F-FDG PET/CT had a lower detection rate than Ga-PSMA PET/CT in patients with a Gleason score of 6-8. F-FDG PET is not inferior to Ga-PSMA PET for detecting BCR with a Gleason score of 9; therefore, F-FDG PET/CT could be considered in BCR patients with a Gleason score of 9. However, Ga-PSMA is a better tracer than F-FDG in PET/CT for treatment decision making in BCR patients with a Gleason score of 6-8.
既往研究表明，¹⁸F-氟脱氧葡萄糖（¹⁸F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）在生化复发（BCR）的低分化前列腺腺癌患者中的诊断敏感性高于高分化腺癌患者，但¹⁸F-FDG PET的性能在高Gleason评分的BCR患者中能否达到前列腺特异性膜抗原（PSMA）PET的效果仍知之甚少。本研究旨在比较¹⁸F-FDG PET/CT和⁶⁸Ga-PSMA PET/CT对BCR患者的疗效，并评估¹⁸F-FDG PET在检测高Gleason评分的BCR方面是否不劣于⁶⁸Ga-PSMA PET。这是一项回顾性、头对头比较研究，于2018年5月至2021年6月在上海交通大学医学院附属仁济医院完成。患者均接受了¹⁸F-FDG和⁶⁸Ga-PSMA PET/CT检查。评估了患者层面和解剖区域层面的BCR检出率。本研究共纳入145例患者。在患者层面和任何解剖区域，¹⁸F-FDG PET/CT（24.1%，35/145）的检出率均低于⁶⁸Ga-PSMA PET/CT（59.3%，86/145；P<0.001）（P<0.05）。前列腺特异性抗原（PSA）水平（P<0.001，比值比[OR]=11.026，95%置信区间[CI]：3.214-37.824）和Gleason评分（P<0.001，OR=20.227，95%CI：5.741-71.267）是¹⁸F-FDG PET/CT检出率的独立预测因素，而PSA水平（P<0.001，OR=4.862，95%CI：2.338-10.110）是⁶⁸Ga-PSMA PET/CT检出率的唯一预测因素。在患者层面（64.3%对71.4%，P=0.567）和任何解剖区域（均P>0.05），Gleason评分为9的患者中，¹⁸F-FDG PET/CT的检出率与⁶⁸Ga-PSMA PET/CT相似，但在Gleason评分为6-8的患者中，¹⁸F-FDG PET/CT的检出率低于⁶⁸Ga-PSMA PET/CT。对于检测Gleason评分为9的BCR，¹⁸F-FDG PET不劣于⁶⁸Ga-PSMA PET；因此，对于Gleason评分为9的BCR患者可考虑使用¹⁸F-FDG PET/CT。然而，在PET/CT中，对于Gleason评分为6-8的BCR患者，⁶⁸Ga-PSMA是比¹⁸F-FDG更好的示踪剂，有助于治疗决策。
