PET imaging of prostate-specific membrane antigen in prostate cancer: current state of the art and future challenges.
PET imaging of prostate-specific membrane antigen in prostate cancer: current state of the art and future challenges.
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DOI：
10.1038/pcan.2016.13
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发表时间：
2016-09
影响因子：
4.8
通讯作者：
Cho SY
中科院分区：
文献类型：
--
作者：
Rowe SP;Gorin MA;Allaf ME;Pienta KJ;Tran PT;Pomper MG;Ross AE;Cho SY
前列腺特异性膜抗原 (PSMA) 是一种在前列腺癌 (PCa) 中高表达的细胞表面酶，目前正在广泛探索作为各种临床背景下分子成像的有希望的靶标。最近的研究已经开发和探索了用于正电子发射断层扫描 (PET) 成像应用的新型抗体和小分子 PSMA 放射性示踪剂，标记有多种放射性核素。通过主要是小型回顾性临床研究，在确定此类 PET 药物的临床效用方面已经取得了很大进展。迄今为止最引人注目的数据是在生化复发性 PCa 的情况下，发现 PSMA 靶向放射性示踪剂在检测局部复发性和转移性 PCa 方面优于传统成像和其他分子成像剂。然而，早期数据表明，尽管术中指导仍有希望，但高危原发性 PCa 患者在确定治疗前的初始淋巴结分期可能有限。 PSMA PET 成像潜在有前景应用的其他例子包括原发性 PCa 的非侵入性表征、PSMA 靶向放射治疗的分期和治疗计划以及寡转移性疾病的局部治疗指导。然而，PCa PSMA PET 成像的所有这些适应症和应用仍然缺乏，需要大规模、前瞻性、系统性的临床试验来验证。随着分子成像、泌尿学、放射肿瘤学和肿瘤医学领域不断定义和完善 PSMA 靶向 PET 成像的实用性，以改善 PCa 患者的管理，此类验证试验是必要的，并且有望即将开展。
Prostate-specific membrane antigen (PSMA) is a cell surface enzyme that is highly expressed in prostate cancer (PCa) and is currently being extensively explored as a promising target for molecular imaging in a variety of clinical contexts. Novel antibody and small-molecule PSMA radiotracers labeled with a variety of radionuclides for positron emission tomography (PET) imaging applications have been developed and explored in recent studies. A great deal of progress has been made in defining the clinical utility of this class of PET agents through predominantly small and retrospective clinical studies. The most compelling data to date has been in the setting of biochemically recurrent PCa, where PSMA-targeted radiotracers have been found to be superior to conventional imaging and other molecular imaging agents for the detection of locally recurrent and metastatic PCa. Early data, however, suggest that initial lymph node staging before definitive therapy in high-risk primary PCa patients may be limited, although intraoperative guidance may still hold promise. Other examples of potential promising applications for PSMA PET imaging include non-invasive characterization of primary PCa, staging and treatment planning for PSMA-targeted radiotherapeutics, and guidance of focal therapy for oligometastatic disease. However, all of these indications and applications for PCa PSMA PET imaging are still lacking and require large, prospective, systematic clinical trials for validation. Such validation trials are needed and hopefully will be forthcoming as the fields of molecular imaging, urology, radiation oncology and medical oncology continue to define and refine the utility of PSMA-targeted PET imaging to improve the management of PCa patients.