^(18)F-PSMA-3Q PET/CT在前列腺癌术后低PSA水平患者中的应用价值

Value of ^(18)F-PSMA-3Q PET/CT in prostate cancer patients with low prostate specific antigen level after radical prostatectomy

目的:探讨^(18)F-前列腺特异膜抗原(PSMA)-3Q PET/CT显像在前列腺癌术后血清前列腺特异抗原(PSA)小于1.00μg/L患者中的应用价值。方法:回顾性分析2021年5月至2022年8月解放军总医院收治的58例(年龄52~82岁)根治性前列腺切除术后PSA小于1.00μg/L患者的^(18)F-PSMA-3Q PET/CT影像及临床资料。根据PSA水平分为0~0.19μg/L组、0.20~0.49μg/L组和0.50~0.99μg/L组。根据分子成像标准化评估标准对^(18)F-PSMA-3Q PET/CT显像的可疑肿瘤病变进行分析,以分子成像PSMA(miPSMA)评分≥1分为可疑复发或可疑转移病灶(简称病灶),比较^(18)F-PSMA-3Q PET/CT显像对不同PSA水平组患者的检出率(χ^(2)检验)。采用两独立样本t检验比较显像阳性和阴性患者的PSA水平。结果:^(18)F-PSMA-3Q PET/CT显像共发现36例患者(62.1%,36/58)的85个病灶,其中寡病灶(1个≤病灶数≤3个)者占91.7%(33/36),多发病灶(病灶数>3个)者占8.3%(3/36)。检出部位:前列腺床部位局部复发者,占5.2%(3/58);骨转移者,占39.7%(23/58);盆腔淋巴结转移者,占37.9%(22/58);腹膜后淋巴结转移者,占12.0%(7/58);左侧锁骨区淋巴结转移者,占5.2%(3/58)。58例患者中,0~0.19μg/L组15例、0.20~0.49μg/L组22例、0.50~0.99μg/L组21例。^(18)F-PSMA-3Q PET/CT显像对3组患者的检出率分别为5/15、59.1%(13/22)和85.7%(18/21),差异有统计学意义(χ^(2)=10.33,P=0.006)。^(18)F-PSMA-3Q PET/CT显像阳性(36例)和阴性(22例)患者的PSA水平差异有统计学意义[(0.48±0.28)与(0.28±0.25)μg/L;t=2.67,P=0.010]。结论:^(18)F-PSMA-3Q PET/CT可用于检测前列腺癌术后PSA水平低于1.00μg/L患者的复发或转移灶。在这类患者中,检出病灶的常见部位依次为骨骼、盆腔淋巴结、腹膜后淋巴结、左侧锁骨区淋巴结及前列腺床部位,且寡病灶患者更为多见。

Objective To evaluate the value of 18F-prostate specific membrane antigen(PSMA)-3Q PET/CT imaging in prostate cancer patients with serum prostate specific antigen(PSA)less than 1.00μg/L after radical prostatectomy.Methods From May 2021 to August 2022,^(18)F-PSMA-3Q PET/CT images and clinical data of 58 patients with prostate cancer(age 52-82 years)after radical prostatectomy with PSA less than 1.00μg/L in Chinese PLA General Hospital were analyzed retrospectively.According to the level of PSA,patients were divided into three groups(0-0.19μg/L group,0.20-0.49μg/L group,and 0.50-0.99μg/L group).18F-PSMA-3Q PET/CT images were analyzed according to the standardized evaluation criteria of molecular imaging,and lesions with the scores of molecular imaging PSMA(miPSMA)≥1 were defined as recurrent or metastatic lesions.The detection rates of ^(18)F-PSMA-3Q PET/CT for patients in different PSA level groups were compared(χ^(2) test).The PSA levels of patients with positive and negative scans were compared by using independent-sample t test.Results Of the 58 patients,36(62.1%,36/58)patients and 85 lesions were found by 18F-PSMA-3Q PET/CT.There was 91.7%(33/36)with oligofocal lesions(1≤number of foci≤3)and 8.3%(3/36)with multiple lesions(number of foci>3).According to the location,5.2%(3/58)of the recurrent lesions were found in the prostatic bed,39.7%(23/58)in the bone lesions,37.9%(22/58)in the pelvic lymph nodes,12.0%(7/58)in the retroperitoneal lymph nodes and 5.2%(3/58)in the left clavicular lymph node metastases.There were 15 cases in 0-0.19μg/L group,22 cases in 0.20-0.49μg/L group,and 21 cases in 0.50-0.99μg/L group.The detection rates of ^(18)F-PSMA-3Q PET/CT in the above groups were 5/15,59.1%(13/22)and 85.7%(18/21),respectively(χ^(2)=10.33,P=0.006).There was significant difference in PSA level between patients with positive(n=36)and negative(n=22) ^(18)F-PSMA-3Q PET/CT scans((0.48±0.28)vs(0.28±0.25)μg/L;t=2.67,P=0.010).Conclusions ^(18)F-PSMA-3Q PET/CT can be used to detect the recurrence or metastasis in prostate cancer patients with PSA level lower than 1.00μg/L after radical prostatectomy.In this kind of patients,the common sites of lesions are bone,pelvic lymph nodes,retroperitoneal lymph nodes,left clavicular lymph nodes and prostatic bed,and oligofocal patients are more common.