不同PSA水平的去势抵抗性前列腺癌患者^(18)F-DCFPyL PET/CT显像特征

^(18)F-DCFPyL PET/CT imaging characteristics of castration-resistant prostate cancer patients with different PSA levels

目的探讨不同PSA水平的去势抵抗性前列腺癌(CRPC)患者^(18)F-DCFPyL PET/CT显像特征。方法回顾性分析2018年1月至2020年12月于解放军总医院行^(18)F-DCFPyL PET/CT检查的50例CRPC患者的影像和临床资料。平均年龄72(54~95)岁。血清总前列腺特异性抗原(tPSA)92.28(0.36~2000.00)ng/ml。根据tPSA水平将患者分为低PSA组(tPSA≤1 ng/ml)9例,中PSA组(1 ng/ml<tPSA≤10 ng/ml)18例,高PSA组(tPSA>10 ng/ml)23例。根据分子成像标准化评估标准对^(18)F-DCFPyL PET/CT成像的可疑肿瘤病变进行分子成像PSMA(miPSMA)评分,并将miPSMA评分≥2分者判断为阳性病灶;根据^(18)F-DCFPyL PET/CT显示的病灶数量分为寡病灶(病灶数量≤3个)组和多病灶(病灶数量>3个)组。总结不同分组患者显像特征。结果本研究50例的^(18)F-DCFPyL PET/CT显像结果均为阳性(^(18)F-DCFPyL摄取程度至少高于肝脏的病灶),其中寡病灶组27例,多病灶组23例。30例前列腺未切除者中,18例存在前列腺癌局部复发;余12例前列腺未切除者和20例前列腺已切除者未见局部复发征象。寡病灶组表现为局部复发、区域淋巴结转移或骨转移。多病灶组表现为多发淋巴结和(或)骨转移,伴或不伴局部复发。低、中、高PSA组中寡病灶患者分别为9、18、4例。寡病灶组27例,22例行局部治疗患者中21例有效;3例行全身治疗均有效;2例未治疗者PSA进展。多病灶组23例,9例阿比特龙治疗患者中6例有效;2例行恩扎卢胺治疗均无效;4例化疗患者中1例有效;2例^(177)Lu-PSMA核素治疗患者中1例有效;1例核素^(89)SrCl^(2)治疗无效;2例放疗均无效;3例未治疗者PSA进展。结论^(18)F-DCFPyL PET/CT显像对CRPC患者病灶的检出率高,对患者后续治疗有潜在指导意义。不同PSA水平CRPC患者的病灶数量不同,低PSA水平患者主要为寡病灶。

Objective To investigate the characteristics of ^(18)F-DCFPyL PET/CT imaging in castration-resistant prostate cancer(CRPC)patients with different PSA levels.Methods The imaging and clinical data of 50 patients with CRPC who underwent ^(18)F-DCFPyL PET/CT examination in Chinese PLA General Hospital from January 2018 to December 2020 were analyzed retrospectively.The average age was 72(54-95)years old.Serum total PSA was 92.28(0.36-2000.00)ng/ml.According to the total PSA level,the patients were divided into low PSA group(total PSA≤1 ng/ml,n=9),medium PSA group(1 ng/ml<total PSA≤10 ng/ml,n=18)and high PSA group(total PSA>10ng/ml,n=23).According to the standardized evaluation standard of molecular imaging,the suspicious tumor lesions on ^(18)F-DCFPyL PET/CT imaging were scored by molecular imaging PSMA(miPSMA),and the miPSMA score≥2 was defined as positive lesions.According to the number of lesions displayed by ^(18)F-DCFPyL PET/CT,patients were divided into oligofocal group(the number of lesions≤3)and multiple lesions group(the number of lesions>3).The imaging characteristics of patients in different groups were summarized.Results The ^(18)F-DCFPyL PET/CT imaging results of 50 cases in this study were all positive,including oligofocal group(n=27)and multiple lesions group(n=23).Of the 30 patients with unresected prostate,18 had local recurrence of the prostate,while the other 12 patients with unresected prostate and 20 patients with resected prostate had no signs of local recurrence.The oligofocal group showed local recurrence,regional lymph node metastasis or bone metastasis.Patients with multiple lesions showed multiple lymph nodes and/or bone metastasis with or without local recurrence.There were 9,18 and 4 patients with oligofoci in low,middle and high PSA groups,respectively.There were 27 patients in the oligonucleogenous group,and 21 of the 22 patients receiving local treatment were effective.All 3 patients treated with systemic treatments were effective.PSA progressed in 2 untreated patients.In the multi-foci group of 23 patients,6 of 9 patients treated with abiraterone were effective.Two patients treated with enzalumide were ineffective.One of the 4 patients with chemotherapy was effective.One of the two patients treated with ^(177)Lu-PSMA nuclide was effective.One case did not respond to treatment with ^(89)SrCl^(2).Radiotherapy failed in 2 cases.PSA progressed in 3 untreated patients.Conclusions ^(18)F-DCFPyLPET/CT imaging has a high detection rate of lesions in patients with CRPC and has potential guiding significance for follow-up treatment.The number of lesions in CRPC patients with different PSA levels was different,and the patients with low PSA levels were mainly oligofoci.