68Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate?
68Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate?
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DOI：
10.1007/s00259-015-3078-6
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发表时间：
2015-07-01
影响因子：
9.1
通讯作者：
Virgolini, Irene J.
中科院分区：
文献类型：
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作者：
Ceci, Francesco;Uprimny, Christian;Virgolini, Irene J.
目的评估前列腺癌根治术后生化复发（BR）的复发性前列腺癌（rPCa）患者PSA水平、PSA动力学和其他因素与病理Ga-68-PSMA PET/CT扫描之间的相关性。方法回顾性评估70例连续rPCa患者的Ga-68-PSMA PET/CT扫描，符合以下所有标准：（a）既往根治性乳腺癌切除术或具有治愈目的的初次放疗;（B）初次治疗后BR或持续高PSA水平;和（c）完整的临床和影像学信息。平均+/- SD PSA水平为3.5 +/- 5.3 ng/mL（中位数1.7，范围0.2 - 32.2 ng/mL），平均+/- SD PSA倍增时间（PSAdt）为6.5 +/- 5.5个月（中位数5.5，范围1.3 - 31.6个月），平均+/- SD PSA速度为7.9 +/- 20.5（中位数2.1，范围0.2 - 147.5 ng/mL/年）。结果70例患者中52例（74.2%）Ga-68-PSMA PET/CT阳性。在30例患者（42.8%）中检测到局限于骨盆的病变。在8例患者（11.4%）中观察到远处病变。在14名患者（20%）中检测到局部加全身病变。PET阳性患者（PSA水平较高，PSAdt较短）和PET阴性患者（PSA水平较低，PSAdt较长）之间的PSA水平（p = 0.017）和PSAdt（p = 0.0001）存在显著差异。ROC分析显示PSAdt6.5个月和PSA 0.83 ng/mL为最佳截断值。在多变量分析中，PSAdt与Ga-68-PSMA PET/CT阳性相关。20例PSA < 2 ng/mL、PSAdt < 6.5个月患者中17例（85%）Ga-68-PSMA PET/CT阳性，16例PSA < 2 ng/mL、PSAdt ≥ 6.5个月患者中3例（18.7%）Ga-68-PSMA PET/CT阳性。PSA和PSAdt是病理性Ga-68-PSMA PET/CT结果的有价值的预测因子。
Purpose To assess the association between PSA levels, PSA kinetics and other factors and a pathological Ga-68-PSMA PET/CT scan in patients with recurrent prostate cancer (rPCa) with biochemical relapse (BR) after radical therapy.Methods Seventy consecutive rPCA patients referred for Ga-68-PSMA PET/CT, matching all the following criteria, were retrospectively evaluated: (a) previous radical prostatectomy or primary radiotherapy with curative intent; (b) BR or persisting high PSA levels after primary treatment; and (c) complete clinical and imaging information. The mean +/- SD PSA level was 3.5 +/- 5.3 ng/mL (median 1.7, range 0.2 - 32.2 ng/mL), the mean +/- SD PSA doubling time (PSAdt) was 6.5 +/- 5.5 months (median 5.5, range 1.3 - 31.6 months), and the mean +/- SD PSA velocity was 7.9 +/- 20.5 (median 2.1, range 0.2 - 147.5 ng/mL/year). Statistical analysis was performed to assess which factors were associated with the detection of rPCa on Ga-68-PSMA PET/CT.Results Ga-68-PSMA PET/CT was positive in 52 of 70 patients (74.2 %). In 30 patients (42.8 %) lesions limited to the pelvis were detected. Distant lesions were observed in 8 of patients (11.4 %). Local plus systemic lesions were detected in 14 patients (20 %). PSA level (p = 0.017) and PSAdt (p = 0.0001) were significantly different between PET-positive patients (higher PSA level, shorter PSAdt) and PET-negative patients (lower PSA, longer PSAdt). ROC analysis showed that PSAdt 6.5 months and PSA 0.83 ng/mL were optimal cut-off values. In multivariate analysis PSAdt was associated with Ga-68-PSMA PET/CT positivity. Ga-68-PSMA PET/CT was positive in 17 of 20 patients (85 %) with PSA < 2 ng/mL and PSAdt < 6.5 months, and in 3 of 16 patients (18.7 %) with PSA < 2 ng/mL and PSAdt >= 6.5 months.Conclusion The great potential of Ga-68-PSMA PET/CT in patients with rPCa and BR was confirmed. PSA and PSAdt were valuable predictors of pathological Ga-68-PSMA PET/CT findings.