Prostate-specific membrane antigen-PET/CT may result in stage migration in prostate cancer: performances, quantitative analysis, and potential criticism in the clinical practice.

IF 1.3 4区 医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Nuclear Medicine Communications Pub Date : 2024-07-01 Epub Date: 2024-04-27 DOI:10.1097/MNM.0000000000001850
Pierpaolo Alongi, Marco Messina, Alessio Pepe, Annachiara Arnone, Viola Vultaggio, Costanza Longo, Elisa Fiasconaro, Alessia Mirabile, Rosaria Ricapito, Livio Blasi, Gaspare Arnone, Carlo Messina
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Abstract

Aim: The early detection of prostate cancer (PCa) metastatic disease with PET imaging leads to stage migration and change of disease management. We aimed to assess the impact on clinical management deriving from prostate-specific membrane antigen (PSMA) imaging with a digital PET/CT during the routine application in the staging and restaging process of PCa.

Material and methods: Eighty consecutive PCa patients underwent 18F-PSMA-1007. Digital PET/CT were retrospectively evaluated and discussed with oncologists to evaluate the impact on clinical management. Performances analysis, correlation among variables also considering semiquantitative parameters have been conducted.

Results: In the whole group of 80 patients at staging (N = 31) and restaging (N = 49), the detection rate of PSMA PET was 85% for all lesions. At staging, the performance analysis resulted in sensitivity 77.6%, specificity 89.5%, negative predictive value (NPV) 77.6%, positive predictive value (PPV) 89.5%, accuracy 85.7%, and area under curve (AUC) 0.87%. The performance of restaging PET in the group of patients with PSA values <1 ng/ml resulted in the following values: sensitivity 66.7%, specificity 92.9%, NPV 85.7%, PPV 81.3%, accuracy 82.6%, and AUC 0.79. Semiquantitative analysis revealed a mean value of SUVmax, metabolic tumor volume, and total lesion PSMA expression with differences in patients with high risk compared to low intermediate. At restaging PET, semiquantitative values of patients with total prostate specific antigen (tPSA) ≤ 1 ng/ml were significantly less than those of the tPSA > 1 ng/ml. A significant impact on clinical management was reported in 46/80 patients (57.5%) based on PSMA PET findings at staging and restaging.

Conclusion: Although PSMA-PET provides optimal performances, its current role in redefining a better staging should be translated in the current clinical scenario about potential improvement in clinical/survival outcomes.

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前列腺特异性膜抗原-PET/CT 可导致前列腺癌分期迁移:临床实践中的表现、定量分析和潜在批评。
目的:通过 PET 成像早期发现前列腺癌(PCa)转移性疾病会导致分期迁移和疾病管理的改变。我们旨在评估前列腺特异性膜抗原(PSMA)成像与数字 PET/CT 在 PCa 分期和重新分期过程中的常规应用对临床治疗的影响:连续80例PCa患者接受了18F-PSMA-1007检查。对数字 PET/CT 进行回顾性评估,并与肿瘤专家讨论评估其对临床管理的影响。结果:在分期(31 例)和重新分期(49 例)的 80 例患者中,PSMA PET 对所有病灶的检出率为 85%。在分期时,性能分析结果为敏感性77.6%、特异性89.5%、阴性预测值(NPV)77.6%、阳性预测值(PPV)89.5%、准确性85.7%、曲线下面积(AUC)0.87%。在 PSA 值为 1 纳克/毫升的患者组中,PET 重分期的效果显著。根据 PSMA PET 在分期和重新分期时的结果,46/80 例患者(57.5%)的临床治疗效果显著:尽管PSMA-PET能提供最佳性能,但其目前在重新定义更好的分期方面所起的作用应在目前的临床情况中得到体现,以潜在地改善临床/生存结果。
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来源期刊
CiteScore
2.20
自引率
6.70%
发文量
212
审稿时长
3-8 weeks
期刊介绍: Nuclear Medicine Communications, the official journal of the British Nuclear Medicine Society, is a rapid communications journal covering nuclear medicine and molecular imaging with radionuclides, and the basic supporting sciences. As well as clinical research and commentary, manuscripts describing research on preclinical and basic sciences (radiochemistry, radiopharmacy, radiobiology, radiopharmacology, medical physics, computing and engineering, and technical and nursing professions involved in delivering nuclear medicine services) are welcomed, as the journal is intended to be of interest internationally to all members of the many medical and non-medical disciplines involved in nuclear medicine. In addition to papers reporting original studies, frankly written editorials and topical reviews are a regular feature of the journal.
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