Xiong Zezhong, Ge Yue, Ma Sheng, Wang Yanan, Li Le, Chao Zheng, Wang Xia, Sulaiman Manan, Li Cong, Luan Yang, Yang Chunguang, Zeng Xing, Yu Gan, Zou Sijuan, Zhu Xiaohua, Wang Shaogang, Hu Zhiquan, Yang Qin, Qin Baolong, Wang Zhihua
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Transl Androl Urol. 2024 Jul 31;13(7):1219-1227. doi: 10.21037/tau-24-15. Epub 2024 Jul 3.
Multiparametric magnetic resonance imaging (mpMRI) is a commonly used method to diagnose pelvic lymph node metastasis (PLNM) in prostate cancer (PCa) patients, but there are few comparative studies on mpMRI and Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) in locally advanced PCa (LAPC) patients. Therefore, we designed a retrospective study to compare the diagnostic value of Ga-PSMA PET/CT and mpMRI for PLNM of LAPC.
A retrospective study was performed on 50 patients with LAPC who underwent radical prostatectomy (RP) in Tongji Hospital from 2021 to 2023. All patients underwent PET/CT and mpMRI examination, and were diagnosed as LAPC before surgery, followed by robot-assisted laparoscopic prostatectomy or laparoscopic RP and extended pelvic lymph node dissection (ePLND). Routine postoperative pathological examination was performed. According to the results, the sensitivity, specificity, positive predictive value, and negative predictive value of Ga-PSMA PET/CT and mpMRI for the diagnosis of PLNM of LAPC were compared.
Among the 50 patients, the mean age was 65.5±10.3 years, the preoperative total serum prostate-specific antigen (PSA) was 30.7±12.3 ng/mL, and the Gleason score was 7 [7, 8]. The difference in diagnostic efficacy between Ga-PSMA PET/CT and mpMRI in the preoperative diagnosis of PLNM of PCa was determined by postoperative pathological results. Based on the number of patients who developed PLNM, the sensitivity, specificity, positive predictive value, and negative predictive value of Ga-PSMA PET/CT were as follows: 93.75%, 100.00%, 100.00%, 97.14%, and 68.75%, 97.06%, 91.67%, 86.84% for mpMRI, respectively. Based on the number of pelvic metastatic lymph nodes, the sensitivity, specificity, positive predictive value, and negative predictive value of Ga-PSMA PET/CT were 95.24%, 100.00%, 100.00%, 99.48%, and 65.08%, 99.13%, 89.13%, 96.30% for mpMRI, respectively. It turned out that PET/CT was more sensitive than mpMRI in detecting PLNM of PCa, and the difference was statistically significant.
Ga-PSMA PET/CT is more sensitive than mpMRI in the detection of PLNM in patients with LAPC. It is a promising method in the diagnosis and preoperative assessment of PLNM in LAPC.
多参数磁共振成像（mpMRI）是诊断前列腺癌（PCa）患者盆腔淋巴结转移（PLNM）的常用方法，但在局部晚期PCa（LAPC）患者中，关于mpMRI与镓-前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）/计算机断层扫描（CT）的比较研究较少。因此，我们设计了一项回顾性研究，比较镓-PSMA PET/CT和mpMRI对LAPC患者PLNM的诊断价值。
对2021年至2023年在同济医院接受根治性前列腺切除术（RP）的50例LAPC患者进行回顾性研究。所有患者均接受PET/CT和mpMRI检查，术前被诊断为LAPC，随后接受机器人辅助腹腔镜前列腺切除术或腹腔镜RP及扩大盆腔淋巴结清扫术（ePLND）。术后进行常规病理检查。根据结果，比较镓-PSMA PET/CT和mpMRI对LAPC患者PLNM诊断的敏感性、特异性、阳性预测值和阴性预测值。
50例患者中，平均年龄为65.5±10.3岁，术前血清总前列腺特异性抗原（PSA）为30.7±12.3 ng/mL，Gleason评分7分[7, 8]。PCa患者术前PLNM诊断中镓-PSMA PET/CT与mpMRI诊断效能的差异由术后病理结果确定。根据发生PLNM的患者数量，镓-PSMA PET/CT的敏感性、特异性、阳性预测值和阴性预测值分别为：93.75%、100.00%、100.00%、97.14%，mpMRI分别为68.75%、97.06%、91.67%、86.84%。根据盆腔转移淋巴结数量，镓-PSMA PET/CT的敏感性、特异性、阳性预测值和阴性预测值分别为95.24%、100.00%、100.00%、99.48%，mpMRI分别为65.08%、99.13%、89.13%、96.30%。结果表明，PET/CT在检测PCa患者PLNM方面比mpMRI更敏感，差异有统计学意义。
镓-PSMA PET/CT在检测LAPC患者PLNM方面比mpMRI更敏感。它是LAPC患者PLNM诊断和术前评估中有前景的方法。
