Rosales Juan J, Betech-Antar Vicky, Mínguez Fernando, Guillén Edgar F, Prieto Elena, Quincoces Gemma, Beorlegui Carmen, Fenor de la Maza María Dolores, Díez-Caballero Fernando, Miñana Bernardino, Pérez-Gracia José Luis, Rodríguez-Fraile Macarena
Department of Nuclear Medicine, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
Department of Nuclear Medicine, Clínica Universidad de Navarra, 28027 Madrid, Spain.
Diagnostics (Basel). 2025 Jan 27;15(3):301. doi: 10.3390/diagnostics15030301.
The aim of this study was to determine whether semiquantitative and volume-based metrics obtained from [Ga]Ga-PSMA-11 PET/CT (PSMA-PET) scans before radical prostatectomy (RP) are associated with PSA persistence after surgery in patients with intermediate- (IR) and high-risk (HR) prostate cancer (PCa). We included 118 consecutive patients (IR = 57; HR = 61) with PCa with a PSMA-PET for initial staging and underwent subsequent RP. Clinical parameters and PSMA-PET metrics in the prostate were obtained to determine the following measurements: SUVmax, SUVmean, Target-to-Background Ratios (TBRs), Prostate Molecular Tumor (pMTV), Prostate Total Lesion Activity (pTLA), Prostate Volume (pV), and Prostate Disease Burden (pDB). The association of PSMA-PET metrics parameters before RP and PSA persistence were analyzed by multivariate logistic regression. SUVmax and volume-based PSMA-PET metrics were significantly higher in patients with ISUP Grade 3-5 vs. ISUP Grade 1-2, and only pMTV, pTLA, and pDB were found to be significantly higher in HR patients, as compared with the IR group. During follow-up, 23 patients showed PSA persistence. pMTV, pTLA, and pDB were significantly higher among patients presenting PSA persistence after RP than in patients with undetectable PSA. Multivariate logistic regression analysis found that lymph node infiltration and pTLA were independent predictors for PSA persistence. A cut-off point of ≥25.1 allowed the best discrimination for PSA persistence (OR: 7.4; IQR: 1.4-39.1; < 0.05). The identified association between PSA persistence and prostate TLA of PSMA-PET at initial staging highlights its potential as a valuable tool to improve risk prediction in prostate cancer patients. Further research is needed to confirm these results.
本研究的目的是确定在根治性前列腺切除术（RP）前从[镓]Ga-PSMA-11 PET/CT（PSMA-PET）扫描中获得的半定量和基于体积的指标是否与中危（IR）和高危（HR）前列腺癌（PCa）患者术后的PSA持续存在相关。我们纳入了118例连续的PCa患者（IR = 57；HR = 61），这些患者进行了PSMA-PET初始分期，并随后接受了RP。获取前列腺的临床参数和PSMA-PET指标以确定以下测量值：SUVmax、SUVmean、靶本比（TBR）、前列腺分子肿瘤体积（pMTV）、前列腺总病变活性（pTLA）、前列腺体积（pV）和前列腺疾病负担（pDB）。通过多因素逻辑回归分析RP前PSMA-PET指标参数与PSA持续存在之间的关联。与ISUP 1-2级相比，ISUP 3-5级患者的SUVmax和基于体积的PSMA-PET指标显著更高，并且与IR组相比，仅发现HR患者的pMTV、pTLA和pDB显著更高。在随访期间，23例患者出现PSA持续存在。RP后出现PSA持续存在的患者中的pMTV、pTLA和pDB显著高于PSA不可检测的患者。多因素逻辑回归分析发现淋巴结浸润和pTLA是PSA持续存在的独立预测因素。≥25.1的截断点对PSA持续存在具有最佳的判别能力（OR：7.4；IQR：1.4 - 39.1；<0.05）。初始分期时PSA持续存在与PSMA-PET的前列腺TLA之间确定的关联突出了其作为改善前列腺癌患者风险预测的有价值工具的潜力。需要进一步研究来证实这些结果。
