Thomas Sarah, Callahan Jason, Conway Paul, Moon Daniel, Morgan Hugh, Ingbritsen Johanna, Munro Melissa, Ware Robert E, Dundee Phil, Hicks Rodney J
Melbourne Theranostic Innovation Centre, Melbourne, Australia.
Icon Cancer Centre, Richmond, Australia.
Eur Urol Open Sci. 2024 Dec 7;71:49-56. doi: 10.1016/j.euros.2024.11.008. eCollection 2025 Jan.
Although prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has impacted the investigation and management of biochemical recurrence (BCR) of prostate cancer, negative scans are common at low rising prostate-specific antigen (PSA) levels. PET/CT devices with an extended axial field-of-view, such as the Siemens Biograph Vision Quadra (Quadra) scanner, have substantially higher sensitivity than conventional field-of-view scanners. Our aim was to assess whether the enhanced signal-to-noise ratios achieved on the Quadra scanner improve detection of low-volume disease and thereby increase detection of PC at low PSA levels.
We analysed data for the first 300 consecutive patients who underwent clinically indicated PSMA PET/CT for BCR using a Quadra scanner. We assessed scan positivity and the location of detected disease by PSA category.
The positivity rate increased with the PSA level from 67% for PSA <0.2 ng/ml to >90% for PSA >1.0 ng/ml ( < 0.05). Disease location also differed by PSA category, with prostate bed recurrence alone identified in 63% of positive cases with PSA <0.2 ng/ml, but <25% of cases with PSA >1.0 ng/ml, and distant metastases present in only 6% of positive cases with PSA <0.2 ng/ml versus >40% of cases with PSA >1.0 ng/ml. In the group with PSA <0.2 ng/ml, pelvic nodal disease without local recurrence was identified in 31% of cases.
In comparison to literature data, the Quadra scanner has substantially higher positivity rates at very low PSA levels. At these levels, disease was largely confined to the pelvis and potentially amenable to salvage radiotherapy. However, more than one-third of these patients had disease exclusively outside the prostate bed, with implications for the efficacy and morbidity of current salvage radiotherapy approaches.
We investigated a new PET/CT scanner (positron emission tomography/computed tomography) for detection of prostate cancer recurrence. This more sensitive scanner had a higher detection rate, particularly for patients with low PSA (prostate-specific antigen) in their blood. Our results suggest that the new scanner can detect disease recurrence earlier and more accurately than standard PET/CT scanners, which can help in planning further treatment.
尽管前列腺特异性膜抗原（PSMA）正电子发射断层扫描/计算机断层扫描（PET/CT）对前列腺癌生化复发（BCR）的检查和治疗产生了影响，但在前列腺特异性抗原（PSA）水平较低且呈上升趋势时，扫描结果为阴性的情况很常见。具有扩展轴向视野的PET/CT设备，如西门子Biograph Vision Quadra（Quadra）扫描仪，其灵敏度比传统视野扫描仪高得多。我们的目的是评估Quadra扫描仪实现的增强信噪比是否能改善对低体积疾病的检测，从而提高在低PSA水平时前列腺癌（PC）的检测率。
我们分析了连续300例因BCR接受临床指示的Quadra扫描仪PSMA PET/CT检查的患者的数据。我们按PSA类别评估扫描阳性率和检测到的疾病位置。
阳性率随PSA水平升高而增加，从PSA<0.2 ng/ml时的67%增至PSA>1.0 ng/ml时的>90%（P<0.05）。疾病位置也因PSA类别而异，在PSA<0.2 ng/ml的阳性病例中，仅前列腺床复发占63%，但在PSA>1.0 ng/ml的病例中<25%，且在PSA<0.2 ng/ml的阳性病例中仅有6%出现远处转移，而在PSA>1.0 ng/ml的病例中这一比例>40%。在PSA<0.2 ng/ml的组中，31%的病例发现有盆腔淋巴结疾病但无局部复发。
与文献数据相比，Quadra扫描仪在极低PSA水平时具有显著更高的阳性率。在这些水平下，疾病主要局限于盆腔，可能适合挽救性放疗。然而，这些患者中有超过三分之一的疾病仅位于前列腺床以外，这对当前挽救性放疗方法的疗效和发病率有影响。
我们研究了一种用于检测前列腺癌复发的新型PET/CT扫描仪（正电子发射断层扫描/计算机断层扫描）。这种更灵敏的扫描仪具有更高的检测率，特别是对于血液中PSA（前列腺特异性抗原）水平较低的患者。我们的结果表明，新型扫描仪比标准PET/CT扫描仪能更早、更准确地检测到疾病复发，这有助于规划进一步的治疗。
