Mohan Parul, Wadhwa Palak, Mahajan Harsh, Kumar Dileep, Aringhieri Giacomo, Cioni Dania
Department of Nuclear Medicine, Mahajan Imaging and Labs, New Delhi, India.
Central Research Institute, Shanghai United Imaging Healthcare, Shanghai, China.
World J Nucl Med. 2025 Feb 27;24(2):144-154. doi: 10.1055/s-0045-1804894. eCollection 2025 Jun.
The objective of this study was to evaluate the clinical utility of gallium-68 [ Ga] prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) with rising prostate-specific antigen (PSA) levels in prostate cancer diagnosis. This is a retrospective, single-center, observational cross-sectional study, which is provided after ethics committee clearance, from May 2, 2022 to June 25, 2022. Study includes sample size of 50 patients with prostate adenocarcinoma with varying PSA levels and Gleason score of 6 to 9 who underwent [ Ga] PSMA PET/CT scan. The patients included in this study underwent PET/CT scan on uMI550 (United Imaging Healthcare, Shanghai, China). All patients were divided into three groups based on PSA levels in ng/mL as: PSA ≤ 0.2 (8%), 0.2 < PSA ≤ 1 (10%), 1 < PSA ≤ 3 (8%), 3 < PSA ≤ 10 (18%), and PSA > 10 (56%). Among 50 scans, at least one PSMA avid lesion was visualized in 41 scans (78.9%). These scans were considered positive and included in this study, rest of the scans had insignificant PSMA uptake and were considered negative. [ Ga] PSMA PET/CT detection rates were 75.0, 20.0, 50.0, 88.90, and 89.3% in patients with PSA ≤ 0.2, 0.2 < PSA ≤ 1, 1 < PSA ≤ 3, 3 < PSA ≤ 10, and PSA > 10, respectively. In addition to prostate bed, lesions were also visualized in lymph nodes (32%), liver (2%), skeleton (28%), and thorax (6%). Considering lesions in the prostate bed a significant direct correlation was detected between maximal standardized uptake value (SUVmax) and PSA value ( = 0.03). PSMA PET/CT has been demonstrated to be an effective method for identifying both low-grade Gleason score tumors and low PSA levels. The study provides support for the use of [ Ga] PSMA PET/CT in conjunction with PSA levels for the evaluation of prostate cancer, including local recurrence and distant metastases. The findings of this study indicate that PSMA PET/CT is an effective method for diagnosing prostate cancer, as it allows for the detection of high SUVmax values in pathological tissues. Furthermore, high sensitivity and detection rates are noted with PSMA PET/CT scan even in cases where PSA levels were low. Therefore, this study demonstrates that [ Ga] PSMA PET/CT is beneficial for the early detection of prostate cancer and the prediction of treatment outcomes.
本研究的目的是评估镓 - 68[⁶⁸Ga]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）在前列腺癌诊断中对前列腺特异性抗原（PSA）水平升高的临床应用价值。
这是一项回顾性、单中心、观察性横断面研究，经伦理委员会批准，于2022年5月2日至2022年6月25日进行。研究纳入了50例前列腺腺癌患者，其PSA水平各异，Gleason评分为6至9分，均接受了[⁶⁸Ga]PSMA PET/CT扫描。本研究中的患者在联影uMI550（中国上海联影医疗科技股份有限公司）上进行了PET/CT扫描。
所有患者根据PSA水平（以ng/mL为单位）分为三组：PSA≤0.2（8%）、0.2＜PSA≤1（10%）、1＜PSA≤3（8%）、3＜PSA≤10（18%）以及PSA＞10（56%）。在50次扫描中，41次扫描（78.9%）可见至少一个PSMA摄取阳性病灶。这些扫描被视为阳性并纳入本研究，其余扫描的PSMA摄取不明显，被视为阴性。PSA≤0.2、0.2＜PSA≤1、1＜PSA≤3、3＜PSA≤10以及PSA＞10的患者中，[⁶⁸Ga]PSMA PET/CT的检出率分别为75.0%、20.0%、50.0%、88.90%和89.3%。除前列腺床外，淋巴结（32%）、肝脏（2%）、骨骼（28%）和胸部（6%）也可见病灶。考虑前列腺床的病灶，最大标准化摄取值（SUVmax）与PSA值之间存在显著直接相关性（r = 0.03）。
PSMA PET/CT已被证明是识别低级别Gleason评分肿瘤和低PSA水平的有效方法。本研究为联合使用[⁶⁸Ga]PSMA PET/CT和PSA水平评估前列腺癌（包括局部复发和远处转移）提供了支持。
本研究结果表明，PSMA PET/CT是诊断前列腺癌的有效方法，因为它能够检测到病理组织中的高SUVmax值。此外，即使在PSA水平较低的情况下，PSMA PET/CT扫描也具有高灵敏度和检出率。因此，本研究表明[⁶⁸Ga]PSMA PET/CT有助于前列腺癌的早期检测和治疗结果的预测。
