Nuclear Medicine Unit, Department of Radiological Sciences, .
Oncology Unit, Department of Surgery, A.R.N.A.S. Civico, Via Piazzale Leotta, Palermo and .
Nucl Med Commun. 2024 Jul 1;45(7):622-628. doi: 10.1097/MNM.0000000000001850. Epub 2024 Apr 27.
The early detection of prostate cancer (PCa) metastatic disease with PET imaging leads to stage migration and change of disease management. We aimed to assess the impact on clinical management deriving from prostate-specific membrane antigen (PSMA) imaging with a digital PET/CT during the routine application in the staging and restaging process of PCa.
Eighty consecutive PCa patients underwent 18F-PSMA-1007. Digital PET/CT were retrospectively evaluated and discussed with oncologists to evaluate the impact on clinical management. Performances analysis, correlation among variables also considering semiquantitative parameters have been conducted.
In the whole group of 80 patients at staging (N = 31) and restaging (N = 49), the detection rate of PSMA PET was 85% for all lesions. At staging, the performance analysis resulted in sensitivity 77.6%, specificity 89.5%, negative predictive value (NPV) 77.6%, positive predictive value (PPV) 89.5%, accuracy 85.7%, and area under curve (AUC) 0.87%. The performance of restaging PET in the group of patients with PSA values <1 ng/ml resulted in the following values: sensitivity 66.7%, specificity 92.9%, NPV 85.7%, PPV 81.3%, accuracy 82.6%, and AUC 0.79. Semiquantitative analysis revealed a mean value of SUVmax, metabolic tumor volume, and total lesion PSMA expression with differences in patients with high risk compared to low intermediate. At restaging PET, semiquantitative values of patients with total prostate specific antigen (tPSA) ≤ 1 ng/ml were significantly less than those of the tPSA > 1 ng/ml. A significant impact on clinical management was reported in 46/80 patients (57.5%) based on PSMA PET findings at staging and restaging.
Although PSMA-PET provides optimal performances, its current role in redefining a better staging should be translated in the current clinical scenario about potential improvement in clinical/survival outcomes.
利用 PET 成像对前列腺癌（PCa）转移疾病进行早期检测可导致分期迁移和疾病管理方式的改变。本研究旨在评估在前列腺癌分期和再分期过程中常规应用前列腺特异性膜抗原（PSMA）成像对临床管理的影响。
80 例连续的 PCa 患者接受了 18F-PSMA-1007 检查。对数字 PET/CT 进行回顾性评估，并与肿瘤学家讨论，以评估其对临床管理的影响。进行了性能分析，并对变量进行了相关性分析，同时考虑了半定量参数。
在 80 例分期（N=31）和再分期（N=49）患者的全组中，PSMA PET 对所有病变的检出率为 85%。在分期时，性能分析结果显示，敏感性为 77.6%，特异性为 89.5%，阴性预测值（NPV）为 77.6%，阳性预测值（PPV）为 89.5%，准确性为 85.7%，曲线下面积（AUC）为 0.87%。在 PSA 值<1ng/ml 的患者中，再分期 PET 的表现如下：敏感性为 66.7%，特异性为 92.9%，NPV 为 85.7%，PPV 为 81.3%，准确性为 82.6%，AUC 为 0.79。半定量分析显示，与低中危患者相比，高危患者的 SUVmax、代谢肿瘤体积和总病变 PSMA 表达的平均值存在差异。在再分期 PET 中，总前列腺特异性抗原（tPSA）≤1ng/ml 患者的半定量值明显低于 tPSA>1ng/ml 患者。根据分期和再分期 PSMA PET 结果，80 例患者中有 46 例（57.5%）报告了对临床管理的显著影响。
尽管 PSMA-PET 提供了最佳的性能，但它在重新定义更好的分期中的作用应转化为当前的临床情况，以提高临床/生存结果的潜力。
