收稿日期: 2023-05-23
网络出版日期: 2024-03-18
基金资助
上海市卫生健康委员会面上项目(202240031)
Value of 18F-PSMA PET/MRI for early diagnosis of recurrence and metastasis in prostate cancer patients after radical prostatectomy
Received date: 2023-05-23
Online published: 2024-03-18
目的： 探讨18氟-前列腺特异性膜抗原（18F-prostate-specific membrane antigen, 18F-PSMA）-1007正电子发射计算机断层显像/磁共振成像系统(positron emission tomography/magnetic resonance imaging, PET/MRI)（以下简称PET/MRI）检查在早期诊断前列腺癌根治术后患者复发、转移中的价值。方法： 连续纳入2019年6月至2022年1月上海交通大学医学院附属瑞金医院收治的前列腺癌根治术后患者143例，均于术后12~60个月内完成PET/MRI检查。统计PET/MRI检查对患者术后肿瘤复发或转移灶的检出率，根据患者的血清前列腺特异性抗原(prostate-specific antigen, PSA)水平分为PSA≤0.2 ng/mL、0.2 ng/mL<PSA≤0.5 ng/mL、0.5 ng/mL<PSA≤4.0 ng/mL、4.0 ng/mL<PSA<10.0 ng/mL和PSA≥10.0 ng/mL 5组，比较不同组中复发或转移灶的检出率。结果： 25%PSA≤0.2 ng/mL、0.2 ng/mL<PSA≤0.5 ng/mL、0.5 ng/mL<PSA≤4.0 ng/mL、4.0 ng/mL<PSA<10.0 ng/mL和PSA≥10.0 ng/mL组中PET/MRI对复发或转移灶的检出率分别为25.00%（6/24）、70.00%（7/10）、66.67%（16/24）、74.07%（20/27）和94.83%（55/58），各组间两两比较检出率差异有统计学意义（P<0.01或P<0.05）。34例（27.64%）患者根据PET/MRI检查结果改变了治疗方案。结论： PET/MRI在PSA未升高的前列腺癌患者中检出了约1/4存在肿瘤复发或转移的患者，且随着血清PSA水平升高，检出率随之升高，提示PET/MRI可早期检出前列腺癌复发、转移灶，有效指导治疗方案的制定。
关键词： 正电子发射断层显像计算机体层摄影术; 磁共振成像; 前列腺癌
周熠磊, 张淼, 郭睿, 周金鑫, 李彪, 李翔 . 18F-PSMA PET/MRI在早期诊断前列腺癌根治术后复发、转移中的价值[J]. 诊断学理论与实践, 2023 , 22(06) : 567 -572 . DOI: 10.16150/j.1671-2870.2023.06.009
Objective: To investigate the value and significance of 18F-prostate-specific membrane antigen (18F-PSMA)-1007 PET/MR for early diagnosis of recurrence and metastasis in prostate cancer patients after radical prostatectomy (RP). Methods: A total of 143 patients with prostate cancer after radical prostatectomy were enrolled during June 2019 to January 2022 in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. All the patients underwent 18F-PSMA-1007 PET/MR imaging within 12 to 60 months after surgery. According to the serum prostate-specific antigen (PSA) levels, patients were divided into 5 groups（PSA≤0.2 ng/mL, 0.2 ng/mL<PSA≤0.5 ng/mL, 0.5 ng/mL<PSA≤4.0 ng/mL, 4.0 ng/mL<PSA<10.0 ng/mL and PSA≥10.0 ng/mL). The detection rates of recurrence or metastasis were compared between different groups. Results: The detection rates of 18F-PSMA-1007 PET/MR for recurrence or metastasis in PSA≤0.2 ng/mL, 0.2 ng/mL<PSA≤0.5 ng/mL, 0.5 ng/mL< PSA ≤ 4.0 ng/mL, 4.0 ng/mL<PSA<10.0 ng/mL and PSA ≥ 10.0 ng/mL groups were 25.00% (6/24)，70.00% (7/10)，66.67% (16/24)，74.07% (20/27) and 94.83% (55/58) respectively, and bilateral comparison between groups revealed that difference in detection rate was statistically significant (P<0.01 or P<0.05). In terms of treatment，34 patients (27.64%) changed their pre-examination treatment regimen based on the results of 18F-PSMA-1007 PET/MR imaging. Conclusions: It reveals that prostate patients with detected recurrence or metastasis account for 25% of those with normal PSA level.The detection rate increases with the increase of PSA levels. It suggests that 18F-PSMA PET/MR can detect recurrence and metastasis in the early stage, which can effectively guide the formulation of treatment plans.
| [1] | CHEN W, ZHENG R, BAADE P D, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2):115-132. |
| [2] | HEIDENREICH A, BASTIAN P J, BELLMUNT J, et al. EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013[J]. Eur Urol, 2014, 65(1):124-137. |
| [3] | 李强. 18F-PSMA-PET/CT在前列腺癌临床诊治中的应用价值探讨[D]. 辽宁: 大连医科大学, 2020. |
| LI Q. Application value of petct in diagnosis and treatment of prostate cancer[D]. Liao Ning: Da Lian Medical University, 2020. | |
| [4] | 沈新平, 叶炯贤, 张娜, 等. 扩散加权成像对诊断前列腺癌的初步研究[J]. 中国医学影像学杂志, 2012, 20(7):485-488. |
| SHEN X P, YE J X, ZHANG N, et al. Preliminary Research for the Diagnosis of Prostate Cancer by Using Diffusion-weighted Imaging[J]. Chin J Med Imaging, 2012, 20(7):485-488. | |
| [5] | H?VELS A M, HEESAKKERS R A, ADANG E M, et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis[J]. Clin Radiol, 2008, 63(4):387-395. |
| [6] | ROWE S P, MACURA K J, CIARALLO A, et al. Comparison of Prostate-Specific Membrane Antigen-Based 18F-DCFBC PET/CT to Conventional Imaging Modalities for Detection of Hormone-Naive and Castration-Resistant Metastatic Prostate Cancer[J]. J Nucl Med, 2016, 57(1):46-53. |
| [7] | HOFFMANN M A, MIEDERER M, WIELER H J, et al. Diagnostic performance of 68Gallium-PSMA-11 PET/CT to detect significant prostate cancer and comparison with 18FEC PET/CT[J]. Oncotarget, 2017, 8(67):111073-111083. |
| [8] | PASCHALIS A, SHEEHAN B, RIISNAES R, et al. Prostate-specific Membrane Antigen Heterogeneity and DNA Repair Defects in Prostate Cancer[J]. Eur Urol, 2019, 76(4):469-478. |
| [9] | 陈肖玥, 戴军, 程然, 等. 18F-PSMA联合18F-FDG双核素PET/MR显像对前列腺癌术前评估的临床价值[J]. 中国临床医学影像杂志, 2021, 32(12):876-883. |
| CHEN X Y, DAI J, CHEN R, et al. Clinical value of 18F-PSMA and 18F-FDG dual-nuclide PET/MR imaging in preoperative evaluation of prostate cancer[J]. J Chin Clin Med Imaging, 2021, 32(12):876-883. | |
| [10] | 陈曙光, 胡鹏程, 樊卫, 等. PET/MR全身显像工作流及协议规划专家共识[J]. 中国临床医学, 2020, 27(4):713-721. |
| CHEN S G, HU P C, FAN W, et al. Expert consensus on PET/MR whole body imaging workflow and protocol planning[J]. Chin J Clin Med, 2020, 27(4):713-721. | |
| [11] | MCGUIRE S. World Cancer Report 2014. Geneva, Switzerland: World Health Organization, International Agency for Research on Cancer, WHO Press, 2015[J]. Adv Nutr, 2016, 7(2):418-419. |
| [12] | 龚杨明, 彭鹏, 吴春晓, 等. 2016年上海市前列腺癌发病和死亡情况与2002—2016年变化趋势分析[J]. 肿瘤, 2023, 43(4):297-306. |
| GONG YM, PENG P, WU CX, et al. Analysis on prostate cancer incidence and mortality in Shanghai 2016 and trends of 2002-2016[J]. Tumor, 2023, 43(04): 297-306. | |
| [13] | 吉进. 循环外泌体mRNA在前列腺癌早期诊断中作用的研究[D]. 中国人民解放军海军军医大学, 2019. |
| JI J. The role of circulating exosome mRNA in the early diagnosis of prostate cancer[D]. PLA Navy Med Univ, 2019. | |
| [14] | 李曾, 吴毅, 程祝忠, 等. 18F-PSMA-1007PET/CT对前列腺癌根治术后生化复发患者早期诊断评估和临床治疗决策影响的价值研究[J]. 中国癌症杂志, 2021, 31(11):1081-1087. |
| LI Z, WU Y, CHEN Z Z, et al. The value of 18F-PSMA-1007 PET/CT in the early diagnosis and clinical treatment of patients with biochemical recurrence after radical prostatectomy[J]. Chin Oncol, 2021, 31(11):1081-1087 | |
| [15] | 张鑫, 任宏伟, 徐良洲, 等. IVIM-DWI对前列腺癌盆腔淋巴结转移瘤的诊断价值[J]. 临床放射学杂志, 2023, 42(7):1178-1181. |
| Zhang X, Ren H W, XU L Z, et al. The Value of Evaluation Pelvic Lymph Node Metastasis in Prostate Cancer with Intravoxel Incoherent Motion(IVIM) Diffusion Weighted Imaging[J]. J Clin Radiol, 2023, 42(7):1178-1181. | |
| [16] | 周小忠, 黄昌华, 刘德樟, 等. 多模态磁共振成像技术联合前列腺特异性抗原对早期前列腺癌的临床诊断价值[J]. 实用医学影像杂志, 2019, 20(2):197-199. |
| ZHOU X Z, HUANG C H, LIU D Z, et al. Clinical diagnostic value of multimodal magnetic resonance imaging combined with prostate-specific antigen in early prostate cancer[J]. J Pract Med Imaging, 2019, 20(2):197-199. | |
| [17] | JADVAR H. Imaging evaluation of prostate cancer with 18F-fluorodeoxyglucose PET/CT: utility and limitations[J]. Eur J Nucl Med Mol Imaging, 2013, 40 Suppl 1(01):S5-10. |
| [18] | 马兰, 杨吉刚. 前列腺癌PET分子影像学[J]. 临床和实验医学杂志, 2014, 13(7):597-599. |
| MA L, YANG J G. PET molecular imaging of prostate cancer[J]. J Clin Exp Med, 2014, 13(7):597-599. | |
| [19] | SILVER D A, PELLICER I, FAIR W R, et al. Prostate-specific membrane antigen expression in normal and malignant human tissues[J]. Clin Cancer Res, 1997, 3(1):81-85. |
| [20] | MANNWEILER S, AMERSDORFER P, TRAJANOSKI S, et al. Heterogeneity of prostate-specific membrane antigen (PSMA) expression in prostate carcinoma with distant metastasis[J]. Pathol Oncol Res, 2009, 15(2):167-172. |
| [21] | BOSTWICK D G, PACELLI A, BLUTE M, et al. Prostate specific membrane antigen expression in prostatic intraepithelial neoplasia and adenocarcinoma: a study of 184 cases[J]. Cancer, 1998, 82(11): 2256-2261. |
| [22] | TROYER J K, BECKETT M L, WRIGHT G L JR. Detection and characterization of the prostate-specific membrane antigen (PSMA) in tissue extracts and body fluids[J]. Int J Cancer, 1995, 62(5):552-558. |
| [23] | AFSHAR-OROMIEH A, HETZHEIM H, KRATOCHWIL C, et al. The Theranostic PSMA Ligand PSMA-617 in the Diagnosis of Prostate Cancer by PET/CT: Biodistribution in Humans, Radiation Dosimetry, and First Evaluation of Tumor Lesions[J]. J Nucl Med, 2015, 56(11):1697-1705. |
| [24] | SHAMNI O, NEBELING B, GRIEVINK H, et al. Fine-tuning of the automated [18F]PSMA-1007 radiosynthesis[J]. J Labelled Comp Radiopharm, 2019, 62(6):252-258. |
/
| 〈 |
|
〉 |
