氟-18标记的前列腺特异性膜抗原PET/CT与MRI在前列腺特异性抗原（PSA）灰色区域诊断前列腺癌中的准确性
The accuracy of fluorine 18-labelled prostate-specific membrane antigen PET/CT and MRI for diagnosis of prostate cancer in PSA grey zone.
作者信息
Luo Liang, Wang Ruiyan, Bai Lu, Shang Jin, Wang Xinyi, Chang Ruxi, Dong Weixuan, Li Yang, Li Yan, Liang Hua, Xie Hongjun, Duan Xiaoyi
机构信息
PET/CT Center, The First Affiliated Hospital of Xi' an Jiaotong University, Xi' an, China.
Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi' an, China.
出版信息
Br J Cancer. 2025 Feb;132(3):253-258. doi: 10.1038/s41416-024-02934-x. Epub 2024 Dec 19.
BACKGROUND
The diagnostic utility of prostate biopsy is limited for prostate cancer (PCa) in the prostate-specific antigen (PSA) grey zone. This study aims to evaluate the diagnostic performance of multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) for PSA grey zone PCa and clinically significant PCa (csPCa).
METHODS
A total of 82 patients with PSA levels ranging from 4 to 10 ng/mL who underwent F-PSMA-1007 PET/CT, mpMRI, and prostate biopsy were prospectively enrolled. For F-PSMA-1007 PET/CT and mpMRI in detecting PCa and csPCa, sensitivity, specificity, and area under the curve (AUC) were assessed using biopsy histology as the standard.
RESULTS
F-PSMA-1007 PET/CT demonstrated better diagnostic performance for PCa than mpMRI (AUC 0.81 vs. 0.63, P = 0.02). 11.0% of patients with PI-RADS 3-5 had no PCa on biopsy, of whom 77.8% were correctly differentiated by F-PSMA-1007 PET/CT. Combined F-PSMA-1007 PET/CT + mpMRI improved sensitivity (92.5% vs. 73.6%) and negative predictive value (NPV, 78.9% vs. 53.3%) compared with mpMRI alone.
CONCLUSIONS
F-PSMA-1007 PET/CT outperformed mpMRI for detecting PCa in the grey zone level of PSA. F-PSMA-1007 PET/CT in combination with mpMRI has additional improvement in sensitivity and NPV for csPCa detection.
CLINICAL TRIAL REGISTRATION
NCT05958004, 2024-07.
背景
在前列腺特异性抗原（PSA）灰色区间，前列腺活检对前列腺癌（PCa）的诊断效用有限。本研究旨在评估多参数磁共振成像（mpMRI）和前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描（PSMA PET/CT）对PSA灰色区间PCa及临床显著PCa（csPCa）的诊断性能。
方法
前瞻性纳入82例PSA水平在4至10 ng/mL之间且接受了F-PSMA-1007 PET/CT、mpMRI及前列腺活检的患者。以活检组织学为标准，评估F-PSMA-1007 PET/CT和mpMRI检测PCa及csPCa的敏感性、特异性和曲线下面积（AUC）。
结果
F-PSMA-1007 PET/CT对PCa的诊断性能优于mpMRI（AUC 0.81对0.63，P = 0.02）。11.0%的PI-RADS 3-5级患者活检未发现PCa，其中77.8%被F-PSMA-1007 PET/CT正确鉴别。与单独使用mpMRI相比，联合F-PSMA-1007 PET/CT + mpMRI提高了敏感性（92.5%对73.6%）和阴性预测值（NPV，78.9%对53.3%）。
结论
在PSA灰色区间水平检测PCa方面，F-PSMA-1007 PET/CT优于mpMRI。F-PSMA-1007 PET/CT与mpMRI联合使用在检测csPCa的敏感性和NPV方面有进一步提高。
临床试验注册号
NCT05958004，2024年7月
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