PDF(Pubmed)
Abstract：
BACKGROUND: Prostate-specific antigen (PSA) is a reliable biomarker for identification of prostate cancer, although a biopsy is still the gold standard for detecting prostate cancer. Similar to higher PIRADS lesions on MRI, the maximal standard uptake value (SUV max) on PSMA PET is linked to a higher likelihood of prostate cancer. Can an mpMRI in conjunction with PSMA PET Scan accurately predict prostate cancer and further trigger omission of biopsy similar to other solid organ urological malignancies?
METHODS: Ga-68 PSMA PET and mpMRI were performed for each patient who was a part of this retrospective study. The PET-positive lesion\'s maximum standardized uptake value (SUVmax) was recorded. Prostate biopsies were performed on patients who had PSMA PET avid lesions and a PIRADS score of 4 or 5. Robot-assisted radical prostatectomy (RARP) was afterward performed on patients who had cancer on their prostate biopsy. The prostatectomy specimen\'s histopathological information was recorded. Cutoff values and correlations between the variables were determined using the ROC curves and Pearson\'s correlation test.
RESULTS: On the basis of suspicious DRE findings or elevated PSA, 70 men underwent mpMRI and PET scans. PIRADS 4 patients had a median (IQR) SUVmax of 8.75 (11.95); whereas, PIRADS 5 patients had an SUVmax of 24.5 (22). The mean SUVmax for patients whose biopsies revealed no cancer was 6.25 ± 1.41. With an AUC of 0.876 on the ROC curve, it was found that there was a significant positive correlation between the results of the mpMRI and PET scans and those of the histopathological investigation. A SUVmax ≥ 8.25 on PSMA PET for a PIRADS 4/5 lesion on mpMRI will aid in correctly predicting malignancy, with a sensitivity of 82.8% and specificity of 100%.
CONCLUSIONS: The findings of this study were positive and indicated that patients with a high suspicion of prostate cancer on mpMRI and PSMA PET (PIRADS ≥ 4 and SUVmax ≥ 8.25). This study substantiates the fact that a combination of mpMRI and PSMA PET can accurately predict localized prostate cancer.
METHODS: Ga-68 PSMA PET and mpMRI were performed for each patient who was a part of this retrospective study. The PET-positive lesion\'s maximum standardized uptake value (SUVmax) was recorded. Prostate biopsies were performed on patients who had PSMA PET avid lesions and a PIRADS score of 4 or 5. Robot-assisted radical prostatectomy (RARP) was afterward performed on patients who had cancer on their prostate biopsy. The prostatectomy specimen\'s histopathological information was recorded. Cutoff values and correlations between the variables were determined using the ROC curves and Pearson\'s correlation test.
RESULTS: On the basis of suspicious DRE findings or elevated PSA, 70 men underwent mpMRI and PET scans. PIRADS 4 patients had a median (IQR) SUVmax of 8.75 (11.95); whereas, PIRADS 5 patients had an SUVmax of 24.5 (22). The mean SUVmax for patients whose biopsies revealed no cancer was 6.25 ± 1.41. With an AUC of 0.876 on the ROC curve, it was found that there was a significant positive correlation between the results of the mpMRI and PET scans and those of the histopathological investigation. A SUVmax ≥ 8.25 on PSMA PET for a PIRADS 4/5 lesion on mpMRI will aid in correctly predicting malignancy, with a sensitivity of 82.8% and specificity of 100%.
CONCLUSIONS: The findings of this study were positive and indicated that patients with a high suspicion of prostate cancer on mpMRI and PSMA PET (PIRADS ≥ 4 and SUVmax ≥ 8.25). This study substantiates the fact that a combination of mpMRI and PSMA PET can accurately predict localized prostate cancer.
摘要：
背景：前列腺特异性抗原（PSA）是鉴定前列腺癌的可靠生物标志物，尽管活检仍然是检测前列腺癌的黄金标准。类似于MRI上更高的PIRADS病变，PSMAPET的最大标准摄取值(SUVmax)与前列腺癌的可能性较高有关.与其他实体器官泌尿系统恶性肿瘤相似，mpMRI与PSMAPET扫描联合能准确预测前列腺癌并进一步引发活检遗漏吗？
方法：对作为本回顾性研究一部分的每位患者进行Ga-68PSMAPET和mpMRI。记录PET阳性病灶的最大标准化摄取值(SUVmax)。对患有PSMAPET狂热病变且PIRADS评分为4或5的患者进行前列腺活检。之后，对前列腺活检中患有癌症的患者进行了机器人辅助的根治性前列腺切除术（RARP）。记录前列腺切除术标本的组织病理学信息。使用ROC曲线和Pearson相关性检验确定截止值和变量之间的相关性。
结果：根据可疑的DRE发现或PSA升高，70名男性接受了mpMRI和PET扫描。PIRADS4患者的中位（IQR）SUVmax为8.75（11.95）；然而，5名患者的SUVmax为24.5（22）。活检未发现癌症的患者的平均SUVmax为6.25±1.41。ROC曲线上的AUC为0.876，发现mpMRI和PET扫描的结果与组织病理学检查的结果之间存在显着正相关。对于MPMRI上的PIRADS4/5病变，PSMAPET的SUVmax≥8.25将有助于正确预测恶性肿瘤，灵敏度为82.8%，特异性为100%。
结论：这项研究的结果是阳性的，表明高度怀疑前列腺癌的患者在mpMRI和PSMAPET（PIRADS≥4和SUVmax≥8.25）。这项研究证实了mpMRI和PSMAPET的组合可以准确预测局部前列腺癌的事实。
方法：对作为本回顾性研究一部分的每位患者进行Ga-68PSMAPET和mpMRI。记录PET阳性病灶的最大标准化摄取值(SUVmax)。对患有PSMAPET狂热病变且PIRADS评分为4或5的患者进行前列腺活检。之后，对前列腺活检中患有癌症的患者进行了机器人辅助的根治性前列腺切除术（RARP）。记录前列腺切除术标本的组织病理学信息。使用ROC曲线和Pearson相关性检验确定截止值和变量之间的相关性。
结果：根据可疑的DRE发现或PSA升高，70名男性接受了mpMRI和PET扫描。PIRADS4患者的中位（IQR）SUVmax为8.75（11.95）；然而，5名患者的SUVmax为24.5（22）。活检未发现癌症的患者的平均SUVmax为6.25±1.41。ROC曲线上的AUC为0.876，发现mpMRI和PET扫描的结果与组织病理学检查的结果之间存在显着正相关。对于MPMRI上的PIRADS4/5病变，PSMAPET的SUVmax≥8.25将有助于正确预测恶性肿瘤，灵敏度为82.8%，特异性为100%。
结论：这项研究的结果是阳性的，表明高度怀疑前列腺癌的患者在mpMRI和PSMAPET（PIRADS≥4和SUVmax≥8.25）。这项研究证实了mpMRI和PSMAPET的组合可以准确预测局部前列腺癌的事实。
