田蓉蓉; 赵铭; 周洁; 薄云峰; 张红雨; 郝海龙; 原凌; 邢军

doi:10.3760/cma.j.cn321828-20190930-00215

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• 临床研究 •

¹⁸F-PSMA-1007 PET/CT对低PSA水平前列腺癌复发的检测价值

中华核医学与分子影像杂志, 2020,40(10) : 589-594. DOI: 10.3760/cma.j.cn321828-20190930-00215

摘要

目的

探讨¹⁸F-前列腺特异膜抗原(PSMA)-1007 PET/CT对低前列腺特异抗原(PSA)水平前列腺癌复发的检测价值。

方法

回顾性分析2018年7月至2019年6月在山西省肿瘤医院行¹⁸F-PSMA-1007 PET/CT显像的可疑生化复发的低PSA水平(<2.0 μg/L)前列腺癌患者45例(年龄59～74岁)。PSA<0.2 μg/L者4例(因例数较少未纳入统计分析)，0.2 μg/L≤PSA<2.0 μg/L者41例。41例中，0.2 μg/L≤PSA<0.5 μg/L 10例，0.5 μg/L≤PSA<1.0 μg/L 14例，1.0 μg/L≤PSA<2.0 μg/L 17例。检测血清PSA水平2周内对患者行PET/CT检查，并依据美国国立综合癌症网络(NCCN)指南将其分为低～中危组(n＝12)和高危组(n＝29)。采用χ²检验、Fisher确切概率法和Spearman秩相关分析数据。

结果

中位随访7(4～15)个月，45例患者经病理或随访证实，复发31例，未复发14例。¹⁸F-PSMA-1007 PET/CT诊断前列腺癌复发的灵敏度为100%(31/31)，特异性为13/14，准确性为97.78%(44/45)。1例PSA<0.2 μg/L患者出现腹膜后淋巴结转移，41例0.2 μg/L≤PSA<2.0 μg/L患者中，31例(75.61%)PET/CT显像至少有1处前列腺癌复发灶，其中局部复发20例，淋巴结转移13例，骨转移14例；PSA水平在0.2 μg/L≤PSA<0.5 μg/L、0.5 μg/L≤PSA<1.0 μg/L、1.0 μg/L≤PSA<2.0 μg/L时复发灶检出率分别为5/10、11/14和15/17，但组间比较差异无统计学意义(χ²＝4.641，P>0.05)。¹⁸F-PSMA-1007 PET/CT阳性结果与血清PSA值、危险度分组呈正相关(r值：0.394和0.384，均P<0.05)。

结论

¹⁸F-PSMA-1007 PET/CT对于低PSA水平的前列腺癌生化复发灶有较高的检测价值。

引用本文: 田蓉蓉, 赵铭, 周洁, 等. ¹⁸F-PSMA-1007 PET/CT对低PSA水平前列腺癌复发的检测价值 [J] . 中华核医学与分子影像杂志, 2020, 40(10) : 589-594. DOI: 10.3760/cma.j.cn321828-20190930-00215.

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前列腺癌是男性常见的恶性肿瘤，原发前列腺癌治疗后临床复发率近30%～40%，前列腺癌根治性手术后连续2次血清前列腺特异抗原(prostate specific antigen, PSA)水平超过0.2 μg/L或在放疗后最低值的基础上PSA上升超过2.0 μg/L提示前列腺癌生化复发^[1]。生化复发的患者是否已经发生临床局部复发或远处转移是制定进一步治疗计划的关键。研究证实早期低PSA水平的生化复发患者如果能得到精准治疗预后会更好^[2,3]，而传统影像学对前列腺癌生化复发的检测灵敏度有限^[4,5]，特别是对于低PSA水平的患者^[6]。近年来，前列腺特异膜抗原(prostate specific membrane antigen, PSMA)靶向PET/CT显像已成为检测前列腺癌复发和转移的新方法^[7,8,9]，欧洲泌尿外科学会(European Association of Urology, EAU)推荐前列腺癌根治术后血清PSA水平大于1.0 μg/L者行PSMA PET/CT显像。本研究主要探讨¹⁸F-PSMA-1007 PET/CT显像对低PSA水平(<2.0 μg/L)前列腺癌复发的检测价值。

贡献者信息

田蓉蓉

山西省肿瘤医院PET/CT中心，太原　030013

赵铭

山西省肿瘤医院PET/CT中心，太原　030013

周洁

山西省肿瘤医院PET/CT中心，太原　030013

薄云峰

山西省肿瘤医院病理科，太原　030013

张红雨

山西省肿瘤医院PET/CT中心，太原　030013

郝海龙

山西省肿瘤医院泌尿外科，太原　030013

原凌

山西省肿瘤医院PET/CT中心，太原　030013

邢军

山西省肿瘤医院PET/CT中心，太原　030013

通信作者

赵铭

山西省肿瘤医院PET/CT中心，太原　030013

Email：zm19701025@163.com

关键词

前列腺肿瘤; 复发; 前列腺特异抗原; 前列腺特异膜抗原; 正电子发射断层显像术; 体层摄影术，X线计算机;

基金项目

山西省重点研发计划项目（201903D321187）

利益冲突

所有作者均声明不存在利益冲突

历史

出版日期：2020-10-25

收稿日期：2019-09-30

Clinical Investigation

Detection value of ¹⁸F-PSMA-1007 PET/CT in the recurrence of prostate cancer at low serum prostate specific antigen level

Tian Rongrong, Zhao Ming, Zhou Jie, Bo Yunfen, Zhang Hongyu, Hao Hailong, Yuan Ling, Xing Jun

Published 2020-10-25

Cite as Chin J Nucl Med Mol Imaging, 2020, 40(10): 589-594. DOI: 10.3760/cma.j.cn321828-20190930-00215

Abstract

Objective

To investigate the value of ¹⁸F-prostate specific membrane antigen (PSMA)-1007 PET/CT in the detection of prostate cancer recurrence at low serum prostate specific antigen (PSA) level.

Methods

From July 2018 to June 2019, 45 patients (age: 59-74 years) with suspected biochemical recurrence of prostate cancer with low PSA level (<2.0 μg/L) who underwent¹⁸F-PSMA-1007 PET/CT examinations in Shanxi Tumor Hospital were retrospectively analyzed. Four patients with PSA<0.2 μg/L were not included in the statistical analysis due to the small sample. Among the remaining 41 patients with 0.2 μg/L≤PSA<2.0 μg/L, 10 were with 0.2 μg/L≤PSA<0.5 μg/L, 14 were with 0.5 μg/L≤PSA<1.0 μg/L, 17 were with 1.0 μg/L≤PSA<2.0 μg/L. PET/CT imaging were performed within 2 weeks after the examination of serum PSA. All patients were divided into low-moderate-risk group (n=12) and high-risk group (n=29) according to the National Comprehensive Cancer Network (NCCN) guidelines. χ² test, Fisher′s exact test and Spearman rank correlation were used to analyze the data.

Results

Patients were followed up for 7 (4-15) months, and all 45 patients were confirmed by pathology or follow-up. There were 31 patients with recurrence and 14 patients without recurrence. The sensitivity, specificity and accuracy were 100%(31/31), 13/14, 97.78%(44/45)respectively. One patient with PSA<0.2 μg/L presented retroperitoneal lymph node metastasis. Among 41 patients with 0.2 μg/L≤PSA<2.0 μg/L, 31(75.61%) were with at least one recurrent lesion by¹⁸F-PSMA-1007 PET/CT. There were 20 cases of local recurrence, 13 cases of lymph node metastasis, 14 cases of bone metastasis. The detection efficacies of ¹⁸F-PSMA-1007 PET/CT were 5/10 for patients with 0.2 μg/L≤PSA<0.5 μg/L, 11/14 for those with 0.5 μg/L≤PSA<1.0 μg/L, and 15/17 for those with 1.0 μg/L≤PSA<2.0 μg/L ( χ²=4.641, P>0.05). The positive results of¹⁸F-PSMA-1007 PET/CT were positively correlated with serum PSA value and risk group (r values: 0.394, 0.384, both P<0.05).

Conclusion

¹⁸F-PSMA-1007 PET/CT is a valuable tool for detecting biochemical recurrence of prostate cancer with low PSA level.

Key words:

Prostatic neoplasms; Recurrence; Prostate-specific antigen; Prostate-specific membrane antigen; Positron-emission tomography; Tomography, X-ray computed

Contributor Information

Tian Rongrong