在局限性原发性前列腺癌患者中，镓-前列腺特异性膜抗原（PSMA）PET/CT上的全病灶前列腺特异性膜抗原（PSMA）活性与前列腺特异性抗原（PSA）及前列腺切除术后组织病理学/临床结果相关吗？
Does total lesion prostate-specific membrane antigen (PSMA) activity on Ga-PSMA PET/CT correlate with PSA and prostatectomy histopathological/clinical outcomes in patients with localised primary prostate cancer?
作者信息
Cheng Jeremy, Adhami Mohammadmehdi, Pham Tho, Nadebaum David P, Baring Ashley, Paul Eldho, Cherk Martin, Grummet Jeremy
机构信息
Department of Urology Alfred Health Melbourne Australia.
Department of Nuclear Medicine and PET Alfred Health Melbourne Australia.
出版信息
BJUI Compass. 2025 Apr 16;6(4):e70015. doi: 10.1002/bco2.70015. eCollection 2025 Apr.
OBJECTIVES
To evaluate the relationship between total lesion PSMA (PSMA), serum PSA, histopathological findings and biochemical recurrence (BCR) in patients with localised prostate cancer (PCa).
PATIENTS AND METHODS
This retrospective study assessed men undergoing Ga-PSMA-11 PET/CT for newly diagnosed or treatment-naïve PCa localised to the prostate gland. Volumes of interest were manually mapped to derive SUV, SUV, PSMA-avid tumour volume and PSMA. PSMA was defined as the product of PSMA-avid primary tumour volume and SUV. Spearman correlation tests evaluated associations between PET parameters and PSA, ISUP GG and radical prostatectomy (RP) histopathological outcomes. Associations between PET parameters and clinical outcomes were determined using Cox proportional hazards regression with results presented as HR and 95% CI.
RESULTS
A total of 200 patients were included, with a median age of 68 (IQR 62-73) years, PSA of 9.5 (6.6-13.0) ng/ml and follow-up of 41 (25-60) months. Median PSMA was 29.6 (14.8-54.8) and SUV 11.0 (6.8-17.9). PSMA and SUV demonstrated a weak correlation with baseline PSA (ρ = 0.334, p < 0.001 and ρ = 0.343, p < 0.001), and PSMA showed a weak correlation with PSA density in the RP subgroup (ρ = 0.242, p = 0.021). Among 109 (54.5%) patients undergoing RP, PSMA and SUV showed a weak correlation with ISUP GG (ρ = 0.233, p = 0.015 and ρ = 0.340, p < 0.001). There was a weak correlation between PSMA and primary tumour stage (ρ = 0.244, p = 0.010) and lymph node stage (ρ = 0.259, p = 0.007). PSMA was significantly higher in those with seminal vesicle involvement (p = 0.011), perineural invasion (p = 0.025) and lymphovascular invasion (p = 0.002). BCR occurred in 46 patients (42%), with a 1% increased risk of BCR per unit increase in PSMA (HR 1.01, 95% CI 1.00-1.02, p = 0.011).
CONCLUSIONS
PSMA correlates with PSA, PSA density, ISUP GG, RP histopathological findings and BCR. As an adjunct to SUV, PSMA has the potential to be a useful prognostic tool. Further research is needed to assess its clinical utility.
目的
评估局限性前列腺癌（PCa）患者的总病变前列腺特异性膜抗原（PSMA）、血清前列腺特异性抗原（PSA）、组织病理学结果与生化复发（BCR）之间的关系。
患者与方法
这项回顾性研究评估了因新诊断或未经治疗的局限性前列腺癌而接受镓-PSMA-11正电子发射断层扫描/计算机断层扫描（PET/CT）的男性患者。通过手动绘制感兴趣区域以得出标准化摄取值（SUV）、SUV、PSMA阳性肿瘤体积和PSMA。PSMA定义为PSMA阳性原发性肿瘤体积与SUV的乘积。Spearman相关性检验评估PET参数与PSA、国际泌尿病理学会（ISUP）分级组（GG）以及根治性前列腺切除术（RP）组织病理学结果之间的关联。使用Cox比例风险回归确定PET参数与临床结果之间的关联，结果以风险比（HR）和95%置信区间（CI）表示。
结果
共纳入200例患者，中位年龄为68（四分位间距62 - 73）岁，PSA为9.5（6.6 - 13.0）ng/ml，随访时间为41（25 - 60）个月。中位PSMA为29.6（14.8 - 54.8），SUV为11.0（6.8 - 17.9）。PSMA和SUV与基线PSA呈弱相关性（ρ = 0.334，p < 0.001和ρ = 0.343，p < 0.001），并且在RP亚组中PSMA与PSA密度呈弱相关性（ρ = 0.242，p = 0.021）。在109例（54.5%）接受RP的患者中，PSMA和SUV与ISUP GG呈弱相关性（ρ = 0.233，p = 0.015和ρ = 0.340，p < 0.001）。PSMA与原发性肿瘤分期（ρ = 0.244，p = 0.010）和淋巴结分期（ρ = 0.259，p = 0.007）呈弱相关性。精囊受累（p = 0.011）、神经周围浸润（p = 0.025）和淋巴管浸润（p = 0.002）患者的PSMA显著更高。46例（42%）患者发生BCR，PSMA每增加一个单位，BCR风险增加1%（HR 1.01，95% CI 1.00 - 1.02，p = 0.011）。
结论
PSMA与PSA、PSA密度、ISUP GG、RP组织病理学结果和BCR相关。作为SUV的辅助指标，PSMA有潜力成为一种有用的预后工具。需要进一步研究以评估其临床实用性。
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