Einspieler Holger, Kluge Kilian, Haberl David, Schatz Katrin, Nics Lukas, Schmitl Stefan, Geist Barbara Katharina, Spielvogel Clemens P, Grubmüller Bernhard, Baltzer Pascal A T, Kramer Gero, Shariat Shahrokh F, Hacker Marcus, Rasul Sazan
Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria.
Department of Urology and Andrology, University Hospital Krems, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria.
Cancers (Basel). 2024 Apr 16;16(8):1514. doi: 10.3390/cancers16081514.
The efficacy of radioligand therapy (RLT) targeting prostate-specific membrane antigen (PSMA) is currently being investigated for its application in patients with early-stage prostate cancer (PCa). However, little is known about PSMA expression in healthy organs in this cohort. Collectively, 202 [Ga]Ga-PSMA-11 positron emission tomography (PET) scans from 152 patients were studied. Of these, 102 PET scans were from patients with primary PCa and hormone-sensitive biochemically recurrent PCa and 50 PET scans were from patients with metastatic castration-resistant PCa (mCRPC) before and after three cycles of [Lu]Lu-PSMA-RLT. PSMA-standardized uptake values (SUV) were measured in multiple organs and PSMA-total tumor volume (PSMA-TTV) was determined in all cohorts. The measured PET parameters of the different cohorts were normalized to the bloodpool and compared using t- or Mann-Whitney U tests. Patients with early-stage PCa had lower PSMA-TTVs (10.39 mL vs. 462.42 mL, < 0.001) and showed different SUVs in the thyroid, submandibular glands, heart, liver, kidneys, intestine, testes and bone marrow compared to patients with advanced CRPC, with all tests showing < 0.05. Despite the differences in the PSMA-TTV of patients with mCRPC before and after [Lu]Lu-PSMA-RLT (462.42 mL vs. 276.29 mL, = 0.023), no significant organ differences in PET parameters were detected. These suggest different degrees of PSMA-ligand binding among patients with different stages of PCa that could influence radiotoxicity during earlier stages of disease in different organs when PSMA-RLT is administered.
目前正在研究靶向前列腺特异性膜抗原（PSMA）的放射性配体疗法（RLT）在早期前列腺癌（PCa）患者中的应用疗效。然而，对于该队列中健康器官的PSMA表达情况知之甚少。总共研究了152例患者的202次[Ga]Ga-PSMA-11正电子发射断层扫描（PET）。其中，102次PET扫描来自原发性PCa和激素敏感的生化复发PCa患者，50次PET扫描来自转移性去势抵抗性PCa（mCRPC）患者，分别在[Lu]Lu-PSMA-RLT三个周期之前和之后进行。在多个器官中测量PSMA标准化摄取值（SUV），并在所有队列中确定PSMA总肿瘤体积（PSMA-TTV）。将不同队列测量的PET参数标准化至血池，并使用t检验或Mann-Whitney U检验进行比较。与晚期CRPC患者相比，早期PCa患者的PSMA-TTV较低（10.39 mL对462.42 mL，<0.001），并且在甲状腺、颌下腺、心脏、肝脏、肾脏、肠道、睾丸和骨髓中的SUV也有所不同，所有检验均显示<0.05。尽管mCRPC患者在[Lu]Lu-PSMA-RLT前后的PSMA-TTV存在差异（462.42 mL对276.29 mL，=0.023），但未检测到PET参数在器官上有显著差异。这些结果表明，不同阶段PCa患者之间PSMA-配体结合程度不同，这可能会在给予PSMA-RLT时影响疾病早期不同器官的放射毒性。
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