Diagnostic Accuracy Of K TI-RADS,ACR TI-RADS And C TI-RADS For Thyroid Nodules:A Comparative Study

BACKGROUND AND PURPOSE:Prostate cancer is a malignant tumor that seriously affects men’s health and is highly heterogeneous.Among them.the risk of failure of primary radical treatment.recurrence and metastasis of high-risk prostate cancer is significantly increased.and accurate initial evaluation and treatment decisions for patients are key to precise treatment.Neoadjuvant therapy may improve patient prognosis and requires accurate screening of the patient population most likely to be benefited.PSMA-PET/CT provides a more accurate and comprehensive detection of prostate cancer lesions and allows assessment of systemic lesions in a single imaging session,which is advantageous for application in high-risk prostate cancer patients.In this study.we propose to apply PSMA-PET/CT for baseline evaluation in high-risk prostate cancer patients receiving neoadjuvant therapy.And to follow up PSA levels after radical surgery to compare the efficacy of PSMA-PET/CT and conventional imaging means in disease staging and metastasis detection.We also further investigated the prognostic predictive value of PSMA-PET/CT.METHODS:A total of 70 male patients with primary high-risk prostate cancer who underwent treatment at Renji Hospital from 2018 to 2021 were included in this study.Patients all underwent baseline systemic evaluation including rectal examination.serum PSA concentration measurement,prostate puncture pathology biopsy.mpMRI examination,bone scan examination.and PSMA-PET/CT examination.Patients received neoadjuvant therapy and underwent robotic-assisted radical prostatectomy with pelvic lymph node dissection under general anesthesia 3-4 weeks after completion of neoadjuvant therapy.Pathological examination of the resected specimens was performed and the patients were followed up for postoperative PSA levels.Baseline clinical characteristics of the patients were statistically described.Hypothesis testing was performed for categorical and ordered categorical variables using chi-square test,Fisher exact test.and rank sum test when necessary:hypothesis testing was performed for SUVmax in each group of patients using the Kruskal-Wallis test.Logistic regression was used to investigate the influence of PSMA-PET/CT-based restaging.location and number of metastases.and other clinical characteristics on outcome.RESULTS:The median SUVmax of patients in this study was 17.6 with a range of 6.0-101.9.There were no significant differences in SUVmax levels between the different ISUP groups for patient pathological biopsies.Patient PSA level groups were associated with SUVmax levels.with statistically significant differences between the PSA=51-100 ng/mL group.PSA>100 ng/mL group and PSA<20 ng/mL group.38 patients(44.3%)were restaged based on PSMA-PET/CT findings.Of these.16 patients with original limited lesions were restaged as locally progressive(32%).and 15 patients with limited as well as 7 locally progressive patients were restaged as metastatic prostate cancer(30%and 35%.respectively).Age.PSA level.and ISUP classification were not associated with restaging escalation whereas patients with limited lesions at original staging were more likely to be restaged to locally progressive and metastatic lesions at PSMA-PET/CT(P=0.041).The proportion of patients who were unable to reach the level of radical cure increased progressively in the PSMA-PET/CT-based determination of localized.locally advanced.and metastatic stage groups(P<0.001):whereas there was no statistical difference in the proportion of patients who were unable to reach the goal of radical cure in the conventional MRI-based determination of limited and locally advanced stage patient groups.The group of patients experiencing restaging escalation by PSMA-PET/CT had a higher chance(25/38.65.8%)of failing to reach the radical level of treatment(for the non-restaged group 11/32.44.0%,P=0.01).The group with extra-pelvic lesions as determined by PSMA-PET/CT had a greater chance of failure of radical treatment(18/23.78.2%)compared with a significantly different risk in the pelvic confinement group(18/47.38.3%.P=0.003).and the relationship between patient baseline age,ISUP staging.PSA level,and type of neoadjuvant therapy received and patient short-term prognosis after radical surgery was not statistically significant.CONCLUSION:This study evaluation explored the correlation between the diagnostic efficacy of PSMA-PET/CT for the baseline assessment of high-risk prostate cancer patients and for the short-term clinical prognosis after neoadjuvant therapy plus radical surgery.It was found to be at or better than MRI in terms of sensitivity,positive and negative predictive values;PSMA-PET/CT-based clinical staging was an independent influencing factor on the short-term prognosis of patients undergoing radical surgery.This study demonstrates and illustrates its value and prospective application in high-risk groups,providing clinical evidence and theoretical basis for the use of PSMA-PET/CT to guide precise and personalized treatment of primary treatment for prostate cancer in high-risk groups.