Al^(18)F-PSMA-BCH PET/CT对前列腺癌根治性切除术后早期复发的检测效能研究

Detection performance of Al^(18)F-PSMA-BCH PET/CT in early relapsed prostate cancer after radical prostatectomy

目的:评估Al^(18)F-前列腺特异膜抗原(PSMA)-BCH PET/CT在前列腺癌根治性切除术后对早期复发病灶检测和定位的价值。方法:回顾性分析2021年7月至2022年7月间于北京大学肿瘤医院接受Al^(18)F-PSMA-BCH PET/CT检查的51例前列腺癌根治性切除术后早期复发患者[年龄49~80(64.8±6.9)岁],所有患者前列腺特异抗原(PSA)<2μg/L。患者依据PSA水平被分为4个亚组:PSA<0.2μg/L、0.2μg/L≤PSA<0.5μg/L、0.5μg/L≤PSA<1μg/L和1μg/L≤PSA<2μg/L组。Al 18F-PSMA-BCH PET/CT检出的病变按前列腺床(包括精囊床),盆腔、腹膜后、纵隔/锁骨上和腋窝淋巴结,骨骼和内脏病变记录分区。不同组间检出率比较采用Fisher确切概率法。结果:51例患者中,30例(58.8%)经Al^(18)F-PSMA-BCH PET/CT显像发现异常显像剂摄取,提示前列腺癌复发,其中60.0%(18/30)局限于盆腔,包括26.7%(8/30)前列腺床局部复发、26.7%(8/30)盆腔局域淋巴结病变、6.6%(2/30)前列腺床复发伴盆腔淋巴结病灶;40.0%(12/30)有盆腔外病变。Al 18F-PSMA-BCH PET/CT在PSA<0.2μg/L、0.2μg/L≤PSA<0.5μg/L、0.5μg/L≤PSA<1μg/L和1μg/L≤PSA<2μg/L组的阳性病灶检出率分别为39.1%(9/23)、6/11、8/9和7/8,其中PSA<0.2μg/L与0.2μg/L≤PSA<0.5μg/L组以及0.5μg/L≤PSA<1μg/L与1μg/L≤PSA<2μg/L组检出率差异均无统计学意义(P值:0.397、0.929)。结论:Al 18F-PSMA-BCH对前列腺癌根治性切除术后早期复发病灶具有高检出率,即使患者PSA水平低于0.2μg/L仍有较高检出价值。

Objective To assess the performance of Al^(18)F-prostate specific membrane antigen(PSMA)-BCH PET/CT in the detection and localization of early recurrent prostate cancer after radical prostatectomy.Methods From July 2021 to July 2022,a cohort of 51 patients(age:49-80(64.8±6.9)years)who underwent Al^(18)F-PSMA-BCH for biochemical recurrence with the prostate specific antigen(PSA)level less than 2μg/L in Peking University Cancer Hospital&Institute were retrospectively analyzed.The patients were stratified into 4 groups(PSA<0.2μg/L,0.2μg/L≤PSA<0.5μg/L,0.5μg/L≤PSA<1μg/L,1μg/L≤PSA<2μg/L groups)according to different PSA levels.Lesions detected by Al18F-PSMA-BCH PET/CT were recorded as prostate bed(including bed of seminal vesicles);pelvic,paraaortic,mediastinal/supraclavicular and axillary lymph nodes;bone lesions and visceral lesions.The detection rates among different groups were compared by Fisher exact test.Results Of 51 patients,30(58.8%)had evidence of abnormal uptake suggestive of recurrent prostate cancer,with 60.0%(18/30)had disease confined to the pelvis,including 26.7%(8/30)had prostate bed recurrence,26.7%(8/30)had pelvic lymph nodes,6.6%(2/30)had prostate bed recurrence with pelvic lymph nodes,while 40.0%(12/30)had extra pelvic disease.The detection rates of Al18F-PSMA-BCH PET/CT in PSA<0.2μg/L,0.2μg/L≤PSA<0.5μg/L,0.5μg/L≤PSA<1μg/L and 1μg/L≤PSA<2μg/L groups were 39.1%(9/23),6/11,8/9 and 7/8,respectively.There were no significant differences of detection rates between PSA<0.2μg/L group and 0.2μg/L≤PSA<0.5μg/L group(P=0.397)and also between 0.5μg/L≤PSA<1μg/L group and 1μg/L≤PSA<2μg/L group(P=0.929).Conclusion Al18F-PSMA-BCH has a high detection rate for early recurrent prostate cancer,even at low PSA levels less than 0.2μg/L.