Beheshti Mohsen, Shahbazi-Akbari Malihe, Hacker Marcus, Loidl Wolfgang, Langsteger Werner
Division of Molecular Imaging and Theranostics, Department of Nuclear Medicne & Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
Department of Nuclear Medicine & Endocrinology, PET/CT Center LINZ, Ordensklinikum, Linz, Austria.
Mol Imaging Biol. 2025 May 28. doi: 10.1007/s11307-025-02020-5.
PURPOSE: There are few prospective studies addressed toward the role of Gallium-labelled prostate-specific membrane antigen-11 ([Ga]Ga-PSMA-11) compared to [F]Fluorocholine ([F]FCH) PET/CT in clinical decision-making as prostate-specific PET-tracers. This study aims to evaluate the impact of PET/CT using [Ga]Ga-PSMA-11 and [F]FCH in clinical management of recurrent prostate cancer (PCa) and correlates imaging findings with clinical characteristics of PCa. PROCEDURES: Forty-six patients with PCa (mean age 68.3 ± 6.3 years) with biochemical recurrence were enrolled in this prospective crossover trial. All patients underwent both [Ga]Ga-PSMA-11 and [F]FCH PET/CT within a maximum interval of 12 days (median 7d). A standard randomization tool randomized the sequence of PET/CT imaging. Clinical decision-making occurred in an interdisciplinary meeting considering PET/CT findings. PET/CT-blinded readings were performed 3 months after imaging followed by a consensus meeting for final interpretation of detected lesions. RESULTS: Both imaging modalities detected 136 total malignant lesions. [Ga]Ga-PSMA-11 and [F]FCH PET/CT detected 125 and 60 lesions with a sensitivity of 96% and 48%, respectively. Tumor-to-background ratios and semi-quantitative PET parameters on [Ga]Ga-PSMA-11 were significantly higher in 54 (41.2%) tracer-avid congruent lesions detected on both imaging modalities. [Ga]Ga-PSMA-11 PET/CT exclusively detected 71 (52.2%) lesions, while 6 (4.4%) lesions were solely seen on [F]FCH PET/CT. [Ga]Ga-PSMA-11 and [F]FCH PET/CT were positive in 35/46 (76%) and 26/46 (57%) patients, respectively. PET/CT imaging led to a major treatment change in 4 (8.7%) patients, of which [F]FCH PET/CT had superior impact in one patient. CONCLUSIONS: [Ga]Ga-PSMA-11 PET/CT revealed superior diagnostic performance to [F]FCH PET/CT in patients with recurrent PCa, specifically with very low PSA levels ≤ 1 ng/ml. Moreover, it led to more accurate staging and clinical management of the disease. [F]FCH PET/CT may play a complementary role in rare, select high-risk cases with negative [Ga]Ga-PSMA-11 PET/CT and ongoing ADT.
目的：与[F]氟胆碱（[F]FCH）PET/CT作为前列腺特异性PET示踪剂在临床决策中的作用相比，针对镓标记的前列腺特异性膜抗原-11（[Ga]Ga-PSMA-11）的前瞻性研究较少。本研究旨在评估使用[Ga]Ga-PSMA-11和[F]FCH的PET/CT在复发性前列腺癌（PCa）临床管理中的影响，并将影像学表现与PCa的临床特征相关联。 程序：46例生化复发的PCa患者（平均年龄68.3±6.3岁）纳入了这项前瞻性交叉试验。所有患者在最长12天（中位数7天）的间隔内接受了[Ga]Ga-PSMA-11和[F]FCH PET/CT检查。使用标准随机工具对PET/CT成像顺序进行随机化。临床决策在考虑PET/CT结果的多学科会议上进行。成像后3个月进行PET/CT盲法读片，随后召开共识会议对检测到的病变进行最终解读。 结果：两种成像方式共检测到136个恶性病变。[Ga]Ga-PSMA-11和[F]FCH PET/CT分别检测到125个和60个病变，灵敏度分别为96%和48%。在两种成像方式均检测到的54个（41.2%）示踪剂摄取一致的病变中，[Ga]Ga-PSMA-11的肿瘤与背景比值和半定量PET参数显著更高。[Ga]Ga-PSMA-11 PET/CT单独检测到71个（52.2%）病变。而[F]FCH PET/CT仅检测到6个（4.4%）病变。[Ga]Ga-PSMA-11和[F]FCH PET/CT分别在35/46（76%）和26/46（57%）的患者中呈阳性。PET/CT成像导致4例（8.7%）患者的治疗方案发生重大改变，其中[F]FCH PET/CT对1例患者产生了更好的影响。 结论：在复发性PCa患者中，[Ga]Ga-PSMA-11 PET/CT显示出比[F]FCH PET/CT更好的诊断性能，特别是在前列腺特异性抗原（PSA）水平≤1 ng/ml的极低水平患者中。此外，它还能更准确地对疾病进行分期和临床管理。在[Ga]Ga-PSMA-11 PET/CT阴性且正在接受雄激素剥夺治疗（ADT）的罕见、特定高危病例中，[F]FCH PET/CT可能发挥补充作用。
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