Amseian Gary, Figueras Marcel, Mases Joel, Mengual Lourdes, Ribal Maria-Jose, Quintero Katherine, Pages Rita, Ingelmo-Torres Mercedes, Roldan Fiorella-Lizzeth, Caratini Rocío, Fuster David, Alcaraz Antonio, Izquierdo Laura, Paredes Pilar
Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain.
Department and Laboratory of Urology, Urology Department, Hospital Clínic Barcelona, Villarroel 170, 08036, Barcelona, Spain.
EJNMMI Res. 2024 Dec 18;14(1):124. doi: 10.1186/s13550-024-01170-x.
Prostate cancer recurrence following primary treatment poses a significant clinical challenge, particularly when detected through biochemical recurrence at low PSA levels. Conventional imaging modalities often fail to localize the disease at this early stage. PSMA PET has demonstrated superior sensitivity in detecting recurrent lesions, even in patients with low PSA. Concurrently, liquid biopsy, through analysis of cell-free DNA (cfDNA), offers a minimally invasive approach for monitoring disease. There is scarce evidence about the association between liquid biopsy and PSMA PET/CT findings. This study aimed to assess the correlation between liquid biopsy and tumor burden assessed by PSMA PET/CT in early recurring prostate cancer patients.
PSMA PET/CT and liquid biopsies of 32 patients in biochemical recurrence were analyzed. 12 patients (37.5%) had no PSMA PET-measurable disease. Four patients (12.5%) presented local recurrence, seven (21.9%) had recurrence in pelvic lymph nodes, one of whom also had local recurrence. Nine patients (28.1%) presented metastatic recurrence, with or without local or nodal recurrence. PSA levels correlated with molecular imaging data (p < 0.05), including whole body PSMA-TV, whole body PSMA-TL, whole body SUVmean and whole body SUVmax. The mean cfDNA fragment size fraction was inversely correlated with tumour burden measured with whole body PSMA-TV, with a Spearman correlation coefficient of -0.451 and a p-value of 0.009. No correlation was found between cfDNA concentration and PET-PSMA data.
This prospective study demonstrated a statistically significant negative correlation between cfDNA fragmentation patterns and PSMA PET/CT volumetric parameters in patients with presumed localized prostate cancer with early biochemical recurrence. These findings underscore the potential of liquid biopsy as a biomarker and a complementary tool to PSMA PET/CT to assess disease progression during the follow-up of these patients.
前列腺癌初次治疗后复发带来了重大的临床挑战，尤其是在低PSA水平通过生化复发检测到时。传统成像方式在疾病早期往往无法定位病灶。PSMA PET在检测复发病灶方面已显示出更高的敏感性，即使是在PSA水平较低的患者中。同时，通过分析游离DNA（cfDNA）进行的液体活检为疾病监测提供了一种微创方法。关于液体活检与PSMA PET/CT检查结果之间的关联，证据稀少。本研究旨在评估早期复发性前列腺癌患者中液体活检与PSMA PET/CT评估的肿瘤负荷之间的相关性。
对32例生化复发患者的PSMA PET/CT和液体活检进行了分析。12例患者（37.5%）没有PSMA PET可测量的疾病。4例患者（12.5%）出现局部复发，7例（21.9%）盆腔淋巴结复发，其中1例同时有局部复发。9例患者（28.1%）出现转移性复发，有或无局部或淋巴结复发。PSA水平与分子成像数据相关（p < 0.05），包括全身PSMA-TV、全身PSMA-TL、全身SUVmean和全身SUVmax。cfDNA片段大小分数均值与全身PSMA-TV测量的肿瘤负荷呈负相关，Spearman相关系数为-0.451，p值为0.009。未发现cfDNA浓度与PET-PSMA数据之间存在相关性。
这项前瞻性研究表明，在假定为局限性前列腺癌且早期生化复发的患者中，cfDNA片段化模式与PSMA PET/CT体积参数之间存在统计学上显著的负相关。这些发现强调了液体活检作为一种生物标志物以及作为PSMA PET/CT的补充工具在评估这些患者随访期间疾病进展方面的潜力。
