Mutevelizade Gozde, Bozdemir Bilal Cagri, Aydin Nazim, Sayit Elvan
Department of Nuclear Medicine, School of Medicine, Manisa Celal Bayar University, 45030 Manisa, Turkey.
Department of Nuclear Medicine, Prof. Dr. Cemil Tascıoglu Hospital, University of Health Sciences, 34785 Istanbul, Turkey.
Diagnostics (Basel). 2025 Jul 15;15(14):1779. doi: 10.3390/diagnostics15141779.
: The aim of this study was to investigate the relationship between the PRIMARY score derived from [Ga]Ga-PSMA PET/CT and key clinical and pathological parameters of prostate cancer aggressiveness, including the PSA level, ISUP Grade Group, and D'Amico risk classification, in patients with biopsy-proven prostate cancer. A secondary aim was to evaluate the interobserver agreement of the PRIMARY score in routine clinical practice. : This retrospective analysis included 51 patients with histopathologically confirmed prostate adenocarcinoma who underwent [Ga]Ga-PSMA PET/CT imaging for staging. PRIMARY scores were determined based on the intraprostatic uptake pattern, intensity, and zonal localization. These scores were compared with PSA levels, ISUP GG, D'Amico risk classification, and histopathological features such as the cribriform pattern, intraductal carcinoma, perineural invasion, extraprostatic extension, and lymphovascular invasion. The PRIMARY scores were independently assigned by a total of three nuclear medicine physicians, and interobserver agreement was calculated using Fleiss' kappa analysis. : Significant associations were found between the PRIMARY scores and the PSA level, ISUP Grade Group, and D'Amico risk classification. The most prevalent score was PRIMARY 5 (54.9%), which was significantly associated with ISUP GG 5 and the high-risk category in D'Amico classification. Among patients with PRIMARY Score 2, a substantial proportion (64.7%) had ISUP GG ≥ 3, and 58.8% were in the high-risk group, highlighting the limitations of binary PRIMARY classification. No statistically significant correlations were found between the PRIMARY scores and specific histopathologic features. Interobserver agreement was excellent (κ = 0.833). : The PRIMARY score demonstrates high reproducibility and clinical relevance in stratifying prostate cancer aggressiveness. However, the findings challenge the reliability of binary classifications, particularly for patients with Score 2, who may still harbor high-grade disease. Integrating imaging-based scores with clinical and histopathological data is essential, particularly for accurate staging and decision-making regarding active surveillance.
本研究的目的是调查经活检证实患有前列腺癌的患者中，[镓]Ga-PSMA PET/CT得出的PRIMARY评分与前列腺癌侵袭性的关键临床和病理参数之间的关系，这些参数包括前列腺特异抗原（PSA）水平、国际泌尿病理学会（ISUP）分级组以及达米科风险分类。次要目的是评估在常规临床实践中PRIMARY评分的观察者间一致性。：这项回顾性分析纳入了51例经组织病理学证实为前列腺腺癌且接受[镓]Ga-PSMA PET/CT成像进行分期的患者。PRIMARY评分是根据前列腺内摄取模式、强度和分区定位来确定的。将这些评分与PSA水平、ISUP GG、达米科风险分类以及组织病理学特征（如筛状模式、导管内癌、神经周围侵犯、前列腺外扩展和淋巴管侵犯）进行比较。PRIMARY评分由总共三名核医学医师独立赋值，并使用Fleiss' kappa分析计算观察者间一致性。：在PRIMARY评分与PSA水平、ISUP分级组和达米科风险分类之间发现了显著关联。最常见的评分是PRIMARY 5（54.9%），它与ISUP GG 5和达米科分类中的高危类别显著相关。在PRIMARY评分2的患者中，很大一部分（64.7%）的ISUP GG≥3，58.8%属于高危组，这突出了PRIMARY二元分类的局限性。在PRIMARY评分与特定组织病理学特征之间未发现统计学上的显著相关性。观察者间一致性极佳（κ = 0.833）。：PRIMARY评分在对前列腺癌侵袭性进行分层方面显示出高再现性和临床相关性。然而，研究结果对二元分类的可靠性提出了挑战，特别是对于评分2的患者，他们可能仍患有高级别疾病。将基于影像的评分与临床和组织病理学数据相结合至关重要，特别是对于准确分期和关于主动监测的决策。
