| Background:Prostate cancer?PCa?is the most common malignancy in the genitourinary system of men,but traditional imaging methods such as X-ray computed tomography?X-CT?,magnetic resonance imaging?MRI?and 18F-FDG positron emission tomography?PET?have limited sensitivity and specificity for the detection of prostate cancer foci,a nd there are still deficiencies in the initial staging and recurrence monitoring of prostate cancer.Therefore,a new imaging method is needed to improve the accuracy of focus detection in order to better assist the clinical formulation of prostate cancer diagnosis and treatment.Prostate specific membrane antigen?PSMA?is a transmembrane glycoprotein overexpressed in prostate cancer cells.In recent years,a variety of imaging agents targeting PSMA have been developed and studied,among which the 68Ga-labeled PET/CT imaging agent 68Ga-PSMA-11 targeting PSMA is the most representative in prostate cancer.It shows exciting results in the initial diagnosis and staging of PCa and the detection of recurrent and metastatic lesions after treatment.At present,st udies have shown that18F-PSMA-1007,as a new type of PET/CT imaging agent for PSMA target imaging,has many advantages compared with 68Ga-PSMA-11,such as owning longer half-life,higher image resolution and very low bladder radioactivity.It seems to have a broader application prospect in clinical and scientific research,but at present,the number of comprehensive studies on the application value of this imaging agent is limited.Its clinical application value in prostate cancer still needs to be further explored.Part? The value of 18F-PSMA-1007 PET/CT in the diagnosis of primary prostate cancer.Objective:The purpose of this study was to evaluate the value of 18F-PSMA-1007PET/CT,a new targeted imaging agent,in the diagnosis and staging of primary prostate cancer.Methods:The cases of primary prostate cancer diagnosed and staged by 18F-PSMA-1007 PET/C T in the first affiliated Hospital of Guangzhou Medical University from August 2019 to February 2020 were retrospectively analyzed.All cases were finally diagnosed by pathological biopsy or clinical follow-up.To analyze the differences of imaging features and PET/CT values between prostate cancer and non-prostate cancer patients,and to find the correlation between TPSA semi-quantitative parameters?SUVmax and SUVmean?and clinical data.The efficacy of semi-quantitative parametersof PET/C T in the diagnosis of prostate cancer was evaluated by drawing the receiver working characteristic curve?ROC curve?and calculating the area under the curve?AUC?,and the best cut-off value for distinguishing prostate cancer lesions from benign prostate lesions by SUVmax was calculated.Results:?1?General clinical data of the cases:a total of 21 patients were included in this study,aged 55 to 79?70.9±7.9?years old,TPSA was 40.46 ng/ml?Q1?Q3:10.08?102.55 ng/ml?.There were 16 cases of prostate cancer?Gleason score,that is,8 cases of GS=7,4 cases of GS=8,4 cases of GS=9?and 5 cases of non-prostate cancer?including 3 cases of benign prostatic hyperplasia,1 case of diffuse large B-cell lymphoma and 1 case of prostate abscess?.?2?There was a moderate correlation between TPSA level and SUVmax and GS?r=0.62,P<0.05?.PET/CT detected at least one positive lesion in all patients,and a total of 76 positive lesions were analyzed.There was significant difference in SUV between lesions with GS>7and GS=7 and benign lesions of the prostate?median SUVmax25.3 vs 11.9 vs 4.9,median SUVmean12.6 vs 9.5 vs 4.9 vs 9.5 vs 4.1,H=15.032,16.338,P<0.05?.The uptake of 18F-PSMA-1007 in prostate cancer was significantly higher than that in benign prostate lesions.There was a certain correlation between the level of SUV and GS,but there was no statistical significance?r=0.41,0.26,P=0.095,0.299?.In addition,76 positive lesions,including non-specific benign lesion and other tumors,also showed a certain degree of 18F-PSMA-1007 accumulation,non-specific benign lesion accounting for 27.6%of all positive lesions?including 10.5%of lymph node hyperplasia,7.9%of benign osteopathy,9.2%of other benign uptake of tuberculosis,ganglion and non-specific inflammation?,and other tumors accounting for 2.6%.?3?The sensitivity,specificity and accuracy of prostate cancer evaluation based on patients were 93.8%?15/16?,60.0%?3/5?and 85.7%?18/21?,respectively.The sensitivity,specificity and accuracy of lesion-based analysis were 94.4%?17/18?,75.0%?9/12?and 86.7%?26/30?,respectively.The best cut-off of semi-quantitative parameters SUVmax and SUVmean for dia gnosis of primary prostate cancer were 8.2,4.2,corresponding AUC were 0.907 and 0.938,the best cut-off for diagnosis of lymph node metastasis were 5.3,4.2,and the corresponding AUC were 1.000.The best cut-off for diagnosis of bone metastasis were 4.8,4.3,and the corresponding AUC were0.848 and 0.841 respectively.Conclusion:18F-PSMA-1007 PET/C T initially shows high diagnostic efficiency in the diagnosis and differential diagnosis of primary prostate cancer.At the same time,there is also a certain proportion of non-specific 18F-PSMA-1007 uptake in other lesions,which needs to be differentiated.Part ? The role of 18F-PSMA-1007 PET/CT in monitoring recurrence and metastasis of prostate cancerObjective: To evaluate the value of 18F-PSMA-1007 PET/C T,a new targeted imaging agent,in the detection of recurrence and metastasis of prostate cancer after treatment.Methods: A retrospective analysis was made on 23 patients with the recurrent and metastatic prostate cancer after 18F-PSMA-1007 PET/CT examination in the first affiliated Hospital of Guangzhou Medical University from August 2019 to February 2020.The efficacy of 18F-PSMA-1007 PET/CT in detecting recurrent and metastatic prostate cancer was evaluated,and the positive rate of 18F-PSMA 1007 PET/CT was compared under different PSA levels and Gleason scores.At the same time,SUVmax was measured at different PSA levels and the relationship between PSA and SUVmax was analyzed.Finally,a preliminary evaluation of the treatment response was made in the cases reexamined with 18F-PSMA-1007 PET/CT after treatment.Results:?1?Detection rate analysis: A total of 23 men patients were enrolled in the study,age 50 to 84?70.1±7.5?years old,TPSA was 2.72 ng/ml?Q1Q3:0.358.25 ng/ml?.At least one positive lesion was found in 19 patients on 18F-PSMA-1007 PET/CT?the overall detection rate was 82.6%?.The median value of TPSA in the positive group was higher than that in the negative group?3.62 ng/ml,Q1Q3:0.908.54 ng/ml vs 0.19 ng Q1Q3:0.010.39 ng/ml,u=6.0,P <0.05?.Grouping analysis showed that the detection rates of PET/CT were 50.0%?2/4?,60.0%?3/5?,100%?5/5?and 100%?9/9?when the PSA levels were <0.2,0.21.0,1.04.0 and >4.0 ng/ml,respectively.There were significant differences among the TPSA groups,and the detection rate was positively correlated with the PSA level?r=0.553,P <0.05?.The detection rates of patients with GS=6,7,8,9 and 10 were 100%?3/3?,83.3%?5/6?,50.0%?1/2?,83.3?5/6?and 75.0%?3/4?,respectively.There was no significant differences in detection rate among GS groups?P =0.808?.Based on the lesion analysis,a total of 72 positive lesions were evaluated?including 17 local recurrent lesions,23 lymph node metastases,22 bone metastases and 10 distant visceral metastases?.There was no significant difference in SUVmax among different parts lesions?H=5.830 P =0.120?.The average number of lesions?number of lesions per group / number of patients?was 0.75,1.40,2.60 and 5.44 per group when TPSA levels were <0.2,0.21.0,1.04.0 and >4.0 ng/ml,respectively.The median SUVmax among the above TPSA groups was 5.2,7.4,7.8 and 11.2,respectively?H=4.359,P =0.225?,SUVmax was positively correlated with TPSA level?r=0.517,P =0.01?.P <0.05).?2?Treatment response monitoring: The response to treatment was evaluated in 2 patients,and the SUVmax of positive lesions decreased to some extent after treatment.Conclusion: 18F-PSMA-1007 PET/CT can sensitively detect recurrent and metastatic lesions of prostate cancer,and the detection rate is positively correlated with the level of TPSA.For treatment monitoring,18F-PSMA-1007 PET/CT may reflect treatment changes more early. |
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