Shen Zhengang, Li Zeng, Li Yunlong, Tang Xiaodi, Lu Jiayi, Chen Li, Cheng Zhu Zhong, Liao Hong, Zhou Shukui
Department of Urology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China.
Chengdu Medical College, Chengdu, China.
J Cancer Res Clin Oncol. 2025 May 4;151(5):155. doi: 10.1007/s00432-025-06184-z.
Prostate cancer (PCa) requires improved diagnostic strategies beyond conventional imaging. This review aimed to evaluate the role of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) in diagnosing advanced PCa. The review analyzed the diagnostic performance of PSMA PET/CT in various clinical contexts, including locoregional staging, extracapsular extension (ECE), seminal vesicle invasion (SVI), pelvic lymph node metastases, distant metastases, and biochemical recurrence (BCR). Further, challenges such as PSMA-negative tumors, need for standardized protocols, and potential of emerging imaging targets (neurotensin receptor 1 and fibroblast activation proteins) were reviewed. The role of artificial intelligence (AI) and advancements in tracer development were explored. PSMA PET/CT demonstrated exceptional specificity for locoregional staging, ECE, and SVI while reducing unnecessary biopsies and optimizing biopsy strategies. The diagnostic accuracy for pelvic lymph node metastases was higher with PSMA PET/CT than with traditional methods, although sensitivity for micrometastasis detection remained challenging. For distant metastases, PSMA PET/CT outperformed bone scintigraphy (BS) and conventional imaging, particularly in identifying bone and atypical lesions. In BCR cases, PSMA PET/CT reliably detected recurrent lesions at low prostate-specific antigen levels, significantly influencing treatment strategies. The review findings indicate that PSMA PET/CT is a superior diagnostic tool for PCa due to its high specificity and accuracy. Despite limitations such as PSMA-negative tumors and sensitivity challenges, advancements in AI, novel imaging targets, and affordable tracer development hold promise for broader clinical adoption. This review underscores the transformative potential of PSMA PET/CT in PCa diagnosis and management, advocating for ongoing research and protocol standardization.
前列腺癌（PCa）需要超越传统成像的改进诊断策略。本综述旨在评估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）在诊断晚期PCa中的作用。该综述分析了PSMA PET/CT在各种临床情况下的诊断性能，包括局部区域分期、包膜外侵犯（ECE）、精囊侵犯（SVI）、盆腔淋巴结转移、远处转移和生化复发（BCR）。此外，还综述了诸如PSMA阴性肿瘤、标准化方案的需求以及新兴成像靶点（神经降压素受体1和成纤维细胞活化蛋白）的潜力等挑战。探讨了人工智能（AI）的作用以及示踪剂开发的进展。PSMA PET/CT在局部区域分期、ECE和SVI方面表现出卓越的特异性，同时减少了不必要的活检并优化了活检策略。PSMA PET/CT对盆腔淋巴结转移的诊断准确性高于传统方法，尽管检测微转移的敏感性仍然具有挑战性。对于远处转移，PSMA PET/CT优于骨闪烁显像（BS）和传统成像，特别是在识别骨和非典型病变方面。在BCR病例中，PSMA PET/CT能够在低前列腺特异性抗原水平可靠地检测到复发病变，显著影响治疗策略。综述结果表明，PSMA PET/CT因其高特异性和准确性，是PCa的一种优越诊断工具。尽管存在诸如PSMA阴性肿瘤和敏感性挑战等局限性，但AI、新型成像靶点和可负担的示踪剂开发的进展有望实现更广泛的临床应用。本综述强调了PSMA PET/CT在PCa诊断和管理中的变革潜力，倡导持续研究和方案标准化。
