The management impact of 68gallium-tris(hydroxypyridinone) prostate-specific membrane antigen (68Ga-THP-PSMA) PET-CT imaging for high-risk and biochemically recurrent prostate cancer
The management impact of 68gallium-tris(hydroxypyridinone) prostate-specific membrane antigen (68Ga-THP-PSMA) PET-CT imaging for high-risk and biochemically recurrent prostate cancer
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DOI：
10.1007/s00259-019-04643-7
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发表时间：
2019-12-23
影响因子：
9.1
通讯作者：
Cook, Gary J. R.
中科院分区：
文献类型：
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作者：
Kulkarni, Meghana;Hughes, Simon;Cook, Gary J. R.
目的确定使用新型Ga-68-前列腺特异性膜抗原（PSMA）试剂盒形式（即三（羟基吡啶酮）（THP）-PSMA）与正电子发射断层扫描-计算机断层扫描（PET-CT）对诊断时高危（HR）前列腺癌患者和生化复发（BCR）患者的临床管理的影响。方法118例连续患者（50例HR，68例BCR）在Ga-68-THP-PSMA PET-CT前在多学科会议上记录了管理计划。患者在注射Ga-68-THP-PSMA（平均159 +/- 21.2 MBq）后60分钟接受PET-CT扫描。记录扫描后管理计划、Gleason评分、前列腺特异性抗原（PSA）和PSA倍增时间（PSAdt）。结果HR组：12/50例（24%）患者发生管理变更（9例跨模态，3例模态内）。PSA < 20 μ g/L患者的管理变更频率（9/26，34.6%）高于PSA > 20 μ g/L患者（3/24，12.5%）。Gleason评分> 8与检测到更多的淋巴结（4/16，25% vs 5/31，16.1%）和骨（2/16，12.5% vs 2/31，6.5%）转移相关。BCR组：23/68例（34%）患者的临床管理发生变化（17例模态间，6例模态内）。68次扫描中有40次（59%）为阳性。PSA < 0.5 μ g/L（0%）、PSA 0.5-1.0 μ g/L（35%）、PSA 1.0-5.0 μ g/L（69%）、PSA 5.0-10.0 μ g/L（91%）、PSAdt < 6个月（56%vs 45.7%）、Gleason评分> 8分（78.9%vs 51.2%）的患者，前列腺癌的阳性率增高。结论Ga-68-THP-PSMA PET-CT可影响大量HR前列腺癌患者的临床治疗，并与PSA相关。尽管PSA < 0.5 μ g/L时扫描阳性率较低，但BCR患者也会发生治疗改变，并与PSA和Gleason评分相关。
Purpose To determine the impact on clinical management of patients with high-risk (HR) prostate cancer at diagnosis and patients with biochemical recurrence (BCR) using a new kit form of Ga-68-prostate-specific membrane antigen (PSMA), namely tris(hydroxypyridinone) (THP)-PSMA, with positron emission tomography-computed tomography (PET-CT). Methods One hundred eighteen consecutive patients (50 HR, 68 BCR) had management plans documented at a multidisciplinary meeting before Ga-68-THP-PSMA PET-CT. Patients underwent PET-CT scans 60-min post-injection of Ga-68-THP-PSMA (mean 159 +/- 21.2 MBq). Post-scan management plans, Gleason score, prostate-specific antigen (PSA) and PSA doubling time (PSAdt) were recorded. Results HR group: 12/50 (24%) patients had management changed (9 inter-modality, 3 intra-modality). Patients with PSA < 20 mu g/L had more frequent management changes (9/26, 34.6%) compared with PSA > 20 mu g/L (3/24, 12.5%). Gleason scores > 8 were associated with detection of more nodal (4/16, 25% vs 5/31, 16.1%) and bone (2/16, 12.5% vs 2/31, 6.5%) metastases. BCR group: Clinical management changed in 23/68 (34%) patients (17 inter-modality, 6 intra-modality). Forty out of 68 (59%) scans were positive. Positivity rate increased with PSA level (PSA < 0.5 mu g/L, 0%; PSA 0.5-1.0 mu g/L, 35%; PSA 1.0-5.0 mu g/L, 69%; PSA 5.0-10.0 mu g/L, 91%), PSAdt of < 6 months (56% vs 45.7%) and Gleason score > 8 (78.9% vs 51.2%). Conclusions Ga-68-THP-PSMA PET-CT influences clinical management in significant numbers of patient with HR prostate cancer pre-radical treatment and is associated with PSA. Management change also occurs in patients with BCR and is associated with PSA and Gleason score, despite lower scan positivity rates at low PSA levels < 0.5 mu g/L.