Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Korean J Radiol. 2024 Nov;25(11):1022-1028. doi: 10.3348/kjr.2024.0439.
We aimed to describe the [F]fluorodeoxyglucose (FDG) and prostate-specific membrane antigen (PSMA) PET/CT findings in Korean men with advanced metastatic castration-resistant prostate cancer (mCRPC).
The results of paired FDG and PSMA PET/CT examinations performed in 42 consecutive men with prostate cancer for treatment planning after failure of anti-androgen therapy and chemotherapy were studied. Tumor lesions with FDG or PSMA uptake intensity higher than that of the liver on visual review were considered positive and noted per patient and tumor site (prostate bed, lymph node, bone, and visceral organ). The presence of unequivocally discordant FDG and PSMA uptake patterns in tumor lesions was assessed. Patients were grouped according to the total tumor volume as seen on each PET/CT scan, and the clinical findings between the patient groups were compared using the Mann-Whitney U test.
On patient-based analysis, the image findings were PSMA+/FDG- in 2 patients, PSMA-/FDG+ in one, and PSMA+/FDG+ in 39 patients. On site-based analysis, the discordance (PSMA+/FDG- or PSMA-/FDG+) rate was 9.5% (4/42) for prostate/bed, 11.9% (5/42) for lymph nodes, 9.5% (4/42) for bones, and 11.9% (5/42) for visceral organs. FDG uptake was higher than PSMA uptake in at least one tumor site in 54.8% (23/42) of patients. Patients with greater total tumor volume on FDG PET/CT than that on PSMA PET/CT ("FDG-dominant pattern") accounted for 28.6% (12/42), and they had significantly shorter time from diagnosis (median 25 months vs. 62 months, = 0.049), and higher aspartate aminotransferase (median 28.5 vs. 22.5, = 0.027) and lactate dehydrogenase (median 341.5 vs. 224.5, = 0.010) levels.
Most patients with advanced mCRPC had tumors with positive findings on both FDG and PSMA PET/CT. However, the uptake patterns varied; 54.8% of the patients had tumor(s) with FDG uptake greater than PSMA uptake, and FDG-dominant pattern was noted in 28.6% of the patients.
我们旨在描述韩国晚期转移性去势抵抗性前列腺癌（mCRPC）男性患者的[F]氟脱氧葡萄糖（FDG）和前列腺特异性膜抗原（PSMA）PET/CT 表现。
对 42 例连续接受抗雄激素治疗和化疗失败后行前列腺癌治疗计划的 FDG 和 PSMA PET/CT 检查结果进行研究。通过视觉审查，FDG 或 PSMA 摄取强度高于肝脏的肿瘤病变被认为是阳性，并按患者和肿瘤部位（前列腺床、淋巴结、骨骼和内脏器官）进行记录。评估了肿瘤病变中 FDG 和 PSMA 摄取模式不一致的存在情况。根据每个 PET/CT 扫描中观察到的总肿瘤体积对患者进行分组，并使用 Mann-Whitney U 检验比较患者组之间的临床发现。
基于患者的分析，图像结果为 2 例 PSMA+/FDG-，1 例 PSMA-/FDG+，39 例 PSMA+/FDG+。基于部位的分析，前列腺/床的不一致（PSMA+/FDG-或 PSMA-/FDG+）率为 9.5%（4/42），淋巴结为 11.9%（5/42），骨骼为 9.5%（4/42），内脏器官为 11.9%（5/42）。在至少一个肿瘤部位，FDG 摄取高于 PSMA 摄取的患者占 54.8%（23/42）。与 PSMA PET/CT 相比，FDG PET/CT 上总肿瘤体积更大的患者（“FDG 优势模式”）占 28.6%（12/42），他们的诊断时间明显缩短（中位数 25 个月比 62 个月， = 0.049），天冬氨酸转氨酶（中位数 28.5 比 22.5， = 0.027）和乳酸脱氢酶（中位数 341.5 比 224.5， = 0.010）水平更高。
大多数晚期 mCRPC 患者的 FDG 和 PSMA PET/CT 检查均有阳性发现。然而，摄取模式不同；54.8%的患者有肿瘤 FDG 摄取高于 PSMA 摄取，28.6%的患者有 FDG 优势模式。
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