Li Yue, Guan Lili, Zhang Xiaoyang, Li Jia, Wang Xinlin, Li Wenbo, Xu Lu, Liu Shuang, Tang Zhaobing, Cui Mengchao, Pang Hua
Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing, 100875, China.
Theranostics. 2025 Mar 10;15(9):4124-4134. doi: 10.7150/thno.108676. eCollection 2025.
To assess the effectiveness of [Ga]Ga-PSFA-01 PET/CT in detecting primary tumors and metastatic lesions in patients with prostate cancer (PCa), and to compare the results with those from [Ga]Ga-PSMA-11 PET/CT and [Ga]Ga-FAPI-04 scans. Patients with histologically proven PCa were prospectively recruited and underwent [Ga]Ga-PSFA-01 PET/CT, of which: 25 participants also underwent [Ga]Ga-PSMA-11 PET/CT scan, 5 patients also underwent [Ga]Ga-FAPI-04 PET/CT scan, 3 patients underwent three modalities imaging. To assess the expression of PSMA and FAP, we obtained a pathological tissue section from a patient and performed immunohistochemical staining analysis. SUV, SUV, SUV and the number of detected lesions were compared by using the Wilcoxon signed-rank test, and the Mc-Nemar test was used to compare detectivity. Correlation between SUV and prostate cancer related clinical indicators was demonstrated with Spearman's ratio. A visual assessment was made to compare the detectability of primary tumors and metastases in different regions. A total of 33 patients with a median age of 70 years (range: 52-89 years) were enrolled. Including 13 patients for initial staging and 20 for recurrence detection. [Ga]Ga-PSFA-01 demonstrated superior performance in both patient-based and lesion-based analyses than [Ga]Ga-PSMA-11 PET/CT. However, [Ga]Ga-PSFA-01 depicted lower uptake in primary tumors (11.13 ± 7.04 vs. 15.44 ± 9.25, p = 0.009), bone metastases (8.50 ± 5.0 vs. 12.43 ± 9.55, p < 0.001) and metastases in other sites (6.05 ± 3.29 vs. 10.73 ± 8.74, p = 0.028) , lower tumor to background ratio (TBR) than [Ga]Ga-PSMA-11 PET/CT (2.86 ± 1.50 vs. 9.50 ± 5.62, p < 0.001). [Ga]Ga-PSFA-01 PET/CT showed more lesions (24 vs. 13, p = 0.18), higher uptake (primary tumors, 10.27 ± 2.42 vs. 7.32 ± 0.17, p = 0.109; bone metastases, 8.14 ± 5.98 vs.4.52 ± 1.22, p = 0.128; pelvic lymph nodes, 5.4 ± 2.83 vs.4.19 ± 1.39, p = 0.655) than [Ga]Ga-FAPI-04 PET/CT. There was also a significantly positive correlation between SUV of prostate lesions with the tPSA levels (r = 0.468, p = 0.016) and fPSA levels (r = 0.518, p = 0.04), a significantly negative correlation with the free-to-total prostate-specific antigen ratio (FPSAR) (r = -0.608, p = 0.012). [Ga]Ga-PSFA-01 PET/CT demonstrated higher detection rates and visual assessment efficacy compared to [Ga]Ga-PSMA-11 PET/CT in PCa patients. While preliminary data suggest that [Ga]Ga-PSFA-01 may also outperform [Ga]Ga-FAPI-04 PET/CT, the sample size for [Ga]Ga-FAPI-04 (n = 5) is limited, and further studies are needed to confirm these findings.
评估[镓]Ga-PSFA-01 PET/CT在检测前列腺癌（PCa）患者原发性肿瘤和转移病灶方面的有效性，并将结果与[镓]Ga-PSMA-11 PET/CT和[镓]Ga-FAPI-04扫描的结果进行比较。前瞻性招募经组织学证实为PCa的患者，并对其进行[镓]Ga-PSFA-01 PET/CT检查，其中：25名参与者还接受了[镓]Ga-PSMA-11 PET/CT扫描，5名患者还接受了[镓]Ga-FAPI-04 PET/CT扫描，3名患者接受了三种模式成像。为了评估PSMA和FAP的表达，我们从一名患者身上获取了病理组织切片并进行了免疫组织化学染色分析。使用Wilcoxon符号秩检验比较SUV、SUV、SUV和检测到的病灶数量，并使用Mc-Nemar检验比较检测率。用Spearman比率证明SUV与前列腺癌相关临床指标之间的相关性。进行视觉评估以比较不同区域原发性肿瘤和转移灶的可检测性。共纳入33例患者，中位年龄70岁（范围：52-89岁）。包括13例初始分期患者和20例复发检测患者。在基于患者和基于病灶的分析中，[镓]Ga-PSFA-01均表现出优于[镓]Ga-PSMA-11 PET/CT的性能。然而，[镓]Ga-PSFA-01在原发性肿瘤（11.13±7.04对15.44±9.25，p = 0.009）、骨转移（8.50±5.0对12.43±9.55，p <0.001）和其他部位转移（6.05±3.29对10.73±8.74，p = 0.028）中的摄取较低，肿瘤与背景比值（TBR）低于[镓]Ga-PSMA-11 PET/CT（2.86±1.50对9.50±5.62，p <0.001）。[镓]Ga-PSFA-01 PET/CT显示出比[镓]Ga-FAPI-04 PET/CT更多的病灶（24对13，p = 0.18）、更高的摄取（原发性肿瘤，10.27±2.42对7.32±0.17，p = 0.109；骨转移，8.14±5.98对4.52±1.22，p = 0.128；盆腔淋巴结，5.4±2.83对4.19±1.39，p = 0.655）。前列腺病灶的SUV与总前列腺特异性抗原（tPSA）水平（r = 0.468，p = 0.016）和游离前列腺特异性抗原（fPSA）水平（r = 0.518，p = 0.04）之间也存在显著正相关，与游离与总前列腺特异性抗原比值（FPSAR）存在显著负相关（r = -0.608，p = 0.012）。与[镓]Ga-PSMA-11 PET/CT相比，[镓]Ga-PSFA-01 PET/CT在PCa患者中显示出更高的检测率和视觉评估效能。虽然初步数据表明[镓]Ga-PSFA-01也可能优于[镓]Ga-FAPI-04 PET/CT，但[镓]Ga-FAPI-04的样本量（n = 5）有限，需要进一步研究来证实这些发现。
