Evaluating F-18-PSMA-1007-PET in primary prostate cancer and comparing it to multi-parametric MRI and histopathology
Evaluating F-18-PSMA-1007-PET in primary prostate cancer and comparing it to multi-parametric MRI and histopathology
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DOI：
10.1038/s41391-020-00292-2
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发表时间：
2020-09-30
影响因子：
4.8
通讯作者：
Nagarajah, James
中科院分区：
文献类型：
--
作者：
Prive, Bastiaan M.;Israel, Bas;Nagarajah, James
背景PSMA-PET是一种用于前列腺癌（PCa）分期的新型成像模式。虽然有几种可用的PSMA配体，但F-18-PSMA-1007特别令人感兴趣，因为它不经肾脏排泄，因此不会损害骨盆区域的成像。因此，本研究旨在研究F-18-PSMA-1007-PET用于PCa的主要分期，并将其与多参数（mp）MRI和组织病理学进行比较。方法对在mpMRI后接受F-18-PSMA-1007-PET检查并随后进行MR引导靶向活检（MRGB）的中高危PCa男性患者进行回顾性研究。根据每例患者和每处病变同时审查可疑mpMRI病变和F-18-PSMA-1007-PET。结果随后进行了评估与组织病理学结果的MRGB，如果进行，根治性直肠癌切除术标本。结果53例患者共发现66个mpMRI可疑病灶，并进行了MRGB检查。两个病灶的最大标准化摄取值（SUVmax）小于健康前列腺组织的平均SUV（max），被视为非PSMA表达。所有PSMA avid肿瘤的SUV（最大值）均高于膀胱/尿液的平均SUV（平均值），因此骨盆区域的所有病变都可以清楚区分。23例患者接受了根治性直肠癌切除术，并对其组织病理学标本进行了评价。F-18-PSMA-1007-PET/CT比mpMRI更常正确分期精囊浸润（即pT3b）（90% vs 76%），而与F-18-PSMA-1007-PET相比，mpMRI更准确地检测囊外扩展（即pT3a）（90% vs 57%）。结论：目前对选定队列的研究表明，mpMRI和F-18-PSMA-1007-PET双重成像可改善原发性PCa的分期。F-18-PSMA-1007-PET/CT的肾清除率较低，可辅助评价膀胱附近的肿瘤。
Background PSMA-PET is a novel imaging modality for the staging of prostate cancer (PCa). While there are several PSMA ligands available, F-18-PSMA-1007 is particularly of interest as it is not renally excreted and therefore does not impair the imaging of the pelvic area. Hence, this study aimed to investigate the F-18-PSMA-1007-PET for the primary staging of PCa and compared it to multi-parametric (mp) MRI and histopathology. Methods A retrospective study was performed of men with intermediate and high-risk PCa patients that underwent a F-18-PSMA-1007-PET after mpMRI with subsequent MR-guided target biopsy (MRGB). Suspicious mpMRI lesions and F-18-PSMA-1007-PET were simultaneously reviewed on both a per patient and per-lesion basis. Results were subsequently evaluated with histopathological outcome of MRGB, and if performed, the radical prostatectomy specimen. Results A total of 66 suspicious mpMRI lesions were identified in 53 patients and underwent MRGB. Two lesions had a maximum standardized uptake value (SUVmax) less than the mean SUV(max)of healthy prostate tissue and were considered as non-PSMA-expressing. All PSMA avid tumors had higher SUV(max)than the mean SUV(mean)of the bladder/urine, therefore all lesions were clearly distinguishable in the pelvic area. Twenty-three patients received a radical prostatectomy of which the histopathology specimens were evaluated. F-18-PSMA-1007-PET/CT correctly staged seminal vesicle invasion (i.e. pT3b) more often than mpMRI (90 vs. 76%), whereas mpMRI more accurately detected extracapsular extension (i.e. pT3a) compared to F-18-PSMA-1007-PET (90% vs 57%). Conclusions The present study of a selected cohort suggest that dual imaging with mpMRI and F-18-PSMA-1007-PET may improve staging of primary PCa. F-18-PSMA-1007-PET/CT had low renal clearance, which could assist the evaluation of tumors in proximity of the bladder.