PSMA-Based [(18)F]DCFPyL PET/CT Is Superior to Conventional Imaging for Lesion Detection in Patients with Metastatic Prostate Cancer.
PSMA-Based [(18)F]DCFPyL PET/CT Is Superior to Conventional Imaging for Lesion Detection in Patients with Metastatic Prostate Cancer.
复制标题
基于PSMA的[（18）F] DCFPYL PET/CT优于传统成像，用于转移性前列腺癌患者的病变检测。
DOI：
10.1007/s11307-016-0957-6
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发表时间：
2016-06
影响因子：
3.1
通讯作者：
Cho SY
中科院分区：
文献类型：
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作者：
Rowe SP;Macura KJ;Mena E;Blackford AL;Nadal R;Antonarakis ES;Eisenberger M;Carducci M;Fan H;Dannals RF;Chen Y;Mease RC;Szabo Z;Pomper MG;Cho SY
目前的护理标准常规成像方式（CIM），如x射线计算机断层扫描（CT）和骨扫描，对于转移性前列腺癌的检测可能受到限制，因此改进的成像方法是一个未满足的临床需求。我们评估了第二代低分子量放射性氟化前列腺特异性膜抗原（PSMA）靶向正电子发射断层扫描（PET）放射性示踪剂[18F]DCFPyL在转移性前列腺癌患者中的应用。9例疑似前列腺癌复发，8例有CIM证据表明前列腺癌转移，1例生化复发。[18F]DCFPyL PET/CT影像学检查。8例患者有同期CIM进行比较。在PET和CIM之间进行了对转移性前列腺癌疑似部位的逐病灶检测比较。使用通用估计方程（GEE）仅截距回归模型计算了检测转移性疾病的多模态一致性的估计比例。在8例可用比较CIM的患者中检测到转移性疾病PET阳性[18F]DCFPyL摄取的139个位点（138个明确，1个模棱两可）。相比之下，只有45个病变在CIM上被识别出来（30个明确，15个模棱两可）。当病变在CIM上呈阴性或模棱两可时，估计这些病变的很大一部分或0.72（95%置信区间（CI） 0.55-0.84）在[18F]DCFPyL PET上呈阳性。相反，在那些在[18F]DCFPyL PET上呈阴性或模棱两可的病变中，估计只有非常小的比例或0.03 （95% CI 0.01-0.07）会在CIM上呈阳性。延迟注射后2小时的时间点PET比注射后1小时的时间点有更高的肿瘤示踪剂摄取和更高的肿瘤与背景比。一种新的psma靶向PET示踪剂[18F]DCFPyL能够发现大量前列腺癌的疑似部位，其中许多部位被CIM隐藏或模糊。本研究为第二代psma靶向PET放射示踪剂用于检测转移性前列腺癌提供了强有力的初步证据，并进一步支持psma靶向PET成像在前列腺癌中的重要性。
Current standard of care conventional imaging modalities (CIM) such as X-ray computed tomography (CT) and bone scan can be limited for detection of metastatic prostate cancer and therefore improved imaging methods are an unmet clinical need. We evaluated the utility of a novel second-generation low molecular weight radiofluorinated prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) radiotracer, [18F]DCFPyL, in patients with metastatic prostate cancer. Nine patients with suspected prostate cancer recurrence, eight with CIM evidence of metastatic prostate cancer and one with biochemical recurrence, were imaged with [18F]DCFPyL PET/CT. Eight of the patients had contemporaneous CIM for comparison. A lesion-by-lesion comparison of the detection of suspected sites of metastatic prostate cancer was carried out between PET and CIM. Statistical analysis for estimated proportions of inter-modality agreement for detection of metastatic disease was calculated accounting for intra-patient correlation using general estimating equation (GEE) intercept-only regression models. One hundred thirty-nine sites of PET positive [18F]DCFPyL uptake (138 definite, 1 equivocal) for metastatic disease were detected in the eight patients with available comparison CIM. By contrast, only 45 lesions were identified on CIM (30 definite, 15 equivocal). When lesions were negative or equivocal on CIM, it was estimated that a large portion of these lesions or 0.72 (95 % confidence interval (CI) 0.55–0.84) would be positive on [18F]DCFPyL PET. Conversely, of those lesions negative or equivocal on [18F]DCFPyL PET, it was estimated that only a very small proportion or 0.03 (95 % CI 0.01–0.07) would be positive on CIM. Delayed 2-h-post-injection time point PET yielded higher tumor radiotracer uptake and higher tumor-to-background ratios than an earlier 1-h-post-injection time point. A novel PSMA-targeted PET radiotracer, [18F]DCFPyL, was able to a large number of suspected sites of prostate cancer, many of which were occult or equivocal by CIM. This study provides strong preliminary evidence for the use of this second-generation PSMA-targeted PET radiotracer for detection of metastatic prostate cancer and lends further support for the importance of PSMA-targeted PET imaging in prostate cancer.