一项将PSMA-PET与FDG-PET用于新诊断的高危前列腺癌分期的前瞻性多中心试验。
A prospective, multi-centre trial of PSMA-PET compared to FDG-PET for staging of newly diagnosed high risk prostate cancer.
作者信息
Roberts Matthew J, Roberts Natasha A, Pelecanos Anita, Yaxley John W, Harley Simon J D, Siriwardana Amila R, Cullen Karla, Prior Marita, Lindsay Karen, Vela Ian, Kuchel Anna, Dhiantravan Nattakorn, Thomas Paul, Pattison David A
机构信息
Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4006, Australia.
Faculty of Medicine, The University of Queensland, Brisbane, Australia.
出版信息
EJNMMI Res. 2025 Jul 24;15(1):92. doi: 10.1186/s13550-025-01265-z.
BACKGROUND
Despite being a potentially attractive alternative molecular imaging modality due to wider availability and association with lethal disease in advanced prostate cancer, the role of fluorodeoxyglucose (FDG)- positron emission tomography (PET) at initial diagnosis compared to Prostate Specific Membrane Antigen (PSMA) PET is yet to be accurately determined. The aim of this study was to evaluate the additive benefit of FDG PET to PSMA PET in patients with newly diagnosed, high risk prostate cancer.
RESULTS
A prospective trial conducted across three sites between October-2021 and January-2023 recruited 32 participants with high risk (EAU classification) prostate cancer staged with PSMA PET-CT. FDG PET-CT was acquired centrally and reported with a standardised template. Median age was 69 years, median PSA was 14 ug/L, and most had PI-RADS 5 scores (59%) and ISUP Grade Group 5 tumours (66%). Overall, FDG-PET did not detect any additional definite/probable metastasis according to physician interpretation. All tumours showed PSMA avidity and higher stage was observed per PSMA-PET in 5 participants. No FDG uptake at the primary tumour occurred in 34% of participants. FDG-PET did not result in a change in management for any participant. PSA remission rates were lower in patients with stage ≥ 3 tumours on MRI (60% vs 94%, p = 0.04). Patient reported outcomes (PROs) were largely stable throughout the study.
CONCLUSIONS
FDG-PET did not provide additive staging information above PSMA-PET or alter management for newly diagnosed high-risk prostate cancer patients.
TRIAL REGISTRATION NUMBER
ANZCTR ACTRN12621001185853. Registered 03-09-2021. Available at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382299.
背景
尽管由于可用性更广且与晚期前列腺癌的致命疾病相关，氟脱氧葡萄糖（FDG）-正电子发射断层扫描（PET）作为一种潜在有吸引力的替代分子成像方式，但与前列腺特异性膜抗原（PSMA）PET相比，其在初始诊断中的作用尚未准确确定。本研究的目的是评估FDG PET对新诊断的高危前列腺癌患者PSMA PET的附加益处。
结果
2021年10月至2023年1月在三个地点进行的一项前瞻性试验招募了32名经PSMA PET-CT分期的高危（欧洲泌尿外科学会分类）前列腺癌患者。FDG PET-CT在中心进行采集，并使用标准化模板报告。中位年龄为69岁，中位前列腺特异性抗原（PSA）为14μg/L，大多数患者的前列腺影像报告和数据系统（PI-RADS）评分为5分（59%），国际泌尿病理学会（ISUP）分级组为5级肿瘤（66%）。总体而言，根据医生的解读，FDG-PET未检测到任何额外的明确/可能转移。所有肿瘤均显示PSMA亲和力，5名参与者通过PSMA-PET观察到更高分期。34%的参与者原发肿瘤未出现FDG摄取。FDG-PET未导致任何参与者的治疗方案改变。MRI上≥3期肿瘤患者的PSA缓解率较低（60%对94%，p = 0.04）。在整个研究过程中，患者报告的结局（PROs）基本稳定。
结论
FDG-PET没有提供高于PSMA-PET的附加分期信息，也未改变新诊断的高危前列腺癌患者的治疗方案。
试验注册号
澳大利亚和新西兰临床试验注册中心（ANZCTR）ACTRN12621001185853。于2021年9月3日注册。可在https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382299获取。
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