18 F-PSMA-1007 PET/CT在初诊前列腺癌精准评估中的价值及对临床治疗决策的影响

背景与目的： ¹⁸ F-前列腺特异性膜抗原（prostate-specific membrane antigen，PSMA）-1007 PET/CT是目前针对前列腺癌（prostate cancer，PCa）的先进影像学评估方法。探讨 ¹⁸ F-PSMA-1007 PET/CT在初诊PCa中对原发灶和转移灶精准诊断的价值及对临床治疗决策的影响。方法：回顾性分析2018年11月—2019年2月在四川省肿瘤医院确诊并行 ¹⁸ F-PSMA-1007PET/CT检查的18例未治疗PCa患者的临床资料，由核医学医师对PET/CT图像进行盲法阅片分析。采用感兴趣区方法半定量计算肿瘤放射性摄取，以最大标准化摄取值（maximum standardized uptake value，SUV max ）表示。评价 ¹⁸ F-PSMA-1007PET/CT对PCa原发灶和远处转移灶的诊断效能，以及对临床治疗决策的影响，并比较PCa组织放射性摄取与PSA及Gleason评分的相关性。结果： ¹⁸ F-PSMA-1007 PET/CT准确诊断了全部18例PCa，肿瘤组织呈局灶性放射性摄取，灵敏度、阳性预测值和准确率均为100%。发现无转移5例（27.8%），转移13例（72.2%），其中10例淋巴结转移（包括4例单纯盆腔淋巴结转移和6例腹膜后等区域外淋巴结转移），10例骨转移，3例内脏（肺）转移，7例（38.9%）符合高肿瘤负荷PCa。18例PCa患者的前列腺原发灶的中位SUV _max 为13.05，PSA和Gleason评分均与SUV _max 没有显著相关性（P＞0.05）。临床治疗策略方面，除1例患者（合并原发性肺癌）放弃治疗，最终有8例改变了原治疗方案，改变方案率为47.1%（8/17）。结论：¹⁸ F-PSMA-1007 PET/CT对PCa原发灶和转移灶均具有很好的诊断价值和诊断效能，有利于精准分期和对患者制订个体化的治疗方案，并显著影响临床治疗决策。

The value of 18 F-PSMA-1007 PET/CT in accurate assessment of newly diagnosed prostate cancer and its impact on clinical treatment decisions

Background and purpose: ¹⁸ F-prostate-specific membrane antigen (PSMA)-1007 PET/CT is an advanced imaging evaluation method for prostate cancer. The purpose of this study was to investigate the value of ¹⁸ F-PSMA-1007 PET/CT in the accurate diagnosis of primary and metastatic foci in patients with newly diagnosed prostate cancer (PCa) and its impact on clinical treatment decisions. Methods: The clinical data of 18 newly diagnosed cases of prostate cancer who showed PSMA-positive lesions on ¹⁸ F-PSMA-1007 images from November 2018 to February 2019 were retrospectively reviewed. Professional nuclear medicine physicians read the images in a blind manner. Radioactive uptake of tumors was calculated semi-quantitatively by region of interest method and expressed by the maximum standardized uptake value (SUV _max ). Diagnostic efficacy for primary and metastatic foci as well as its impact on clinical treatment decisions of ¹⁸ F-PSMA-1007 PET/CT was evaluated, and the correlation between tumor uptake and PSA, Gleason score was further evaluated. Results: ¹⁸ F-PSMA-1007 PET/CT accurately detected all 18 PCa patients, and the sensitivity, positive predictive value and accuracy were 100% respectively. Tumor tissues of PCa showed focal radioactivity uptake. No metastasis was found in 5 cases (27.8%), and metastasis was found in 13 cases (72.2%). Ten patients had positive finding n the lymph node metastasis (including 4 cases of simple pelvic lymph node metastasis and 6 cases of retroperitoneal extra-regional lymph node metastasis). There were 10 cases of bone metastasis and 3 cases of visceral (lung) metastasis, and 7 cases (38.9%) were PCa with high tumor load. The median SUV _max of 18 patients was 13.05. SUV _max of the PCa patients had no significant relation with PSA and Gleason Score (P＞0.05). In terms of clinical treatment decisions, except for 1 patient (with primary lung cancer) who gave up treatment, 8 patients changed the original treatment plan, and the change rate was 47.1% (8/17). Conclusion: ¹⁸ F-PSMA-1007 PET/CT has good diagnostic value and efficiency for the detection of the primary and metastatic foci in PCa, which is conducive to accurate staging and individualized treatment, and significantly affects clinical treatment decisions.