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Abstract：
BACKGROUND: prostate-specific membrane antigen (PSMA) ligand PET has been recently incorporated into international guidelines for several different indications in prostate cancer (PCa) patients. However, there are still some open questions regarding the role of PSMA ligand PET in castration-resistant prostate cancer (CRPC). The aim of this work is to assess the clinical value of PSMA ligand PET/CT in patients with CRPC.
RESULTS: PSMA ligand PET has demonstrated higher detection rates in comparison to conventional imaging and allows for a significant reduction in the number of M0 CRPC patients. However, its real impact on patients\' prognosis is still an open question. Moreover, in CRPC patients, PSMA ligand PET presents some sensitivity and specificity limitations. Due to its heterogeneity, CRPC may present a mosaic of neoplastic clones, some of which could be PSMA-/FDG+, or vice versa. Likewise, unspecific bone uptake (UBU) and second primary neoplasms (SNPs) overexpressing PSMA in the neoangiogenic vessels represent potential specificity issues. Integrated multi-tracer imaging (PSMA ligand and [18F]FDG PET) together with a multidisciplinary discussion could allow for reaching the most accurate evaluation of each patient from a precision medicine point of view.
RESULTS: PSMA ligand PET has demonstrated higher detection rates in comparison to conventional imaging and allows for a significant reduction in the number of M0 CRPC patients. However, its real impact on patients\' prognosis is still an open question. Moreover, in CRPC patients, PSMA ligand PET presents some sensitivity and specificity limitations. Due to its heterogeneity, CRPC may present a mosaic of neoplastic clones, some of which could be PSMA-/FDG+, or vice versa. Likewise, unspecific bone uptake (UBU) and second primary neoplasms (SNPs) overexpressing PSMA in the neoangiogenic vessels represent potential specificity issues. Integrated multi-tracer imaging (PSMA ligand and [18F]FDG PET) together with a multidisciplinary discussion could allow for reaching the most accurate evaluation of each patient from a precision medicine point of view.
摘要：
背景：前列腺特异性膜抗原（PSMA）配体PET最近已被纳入前列腺癌（PCa）患者几种不同适应症的国际指南。然而,关于PSMA配体PET在去势抵抗性前列腺癌(CRPC)中的作用仍有一些悬而未决的问题.这项工作的目的是评估PSMA配体PET/CT在CRPC患者中的临床价值。
结果：与常规成像相比，PSMA配体PET的检出率更高，并且可以显着减少M0CRPC患者的数量。然而,它对患者预后的真正影响仍然是一个悬而未决的问题。此外，在CRPC患者中，PSMA配体PET存在一些灵敏度和特异性限制。由于其异质性，CRPC可能呈现肿瘤克隆的马赛克，其中一些可能是PSMA-/FDG+，反之亦然。同样，非特异性骨摄取（UBU）和在新血管生成血管中过度表达PSMA的第二原发性肿瘤（SNP）代表了潜在的特异性问题。集成的多示踪剂成像（PSMA配体和[18F]FDGPET）以及多学科讨论可以从精确医学的角度对每位患者进行最准确的评估。
结果：与常规成像相比，PSMA配体PET的检出率更高，并且可以显着减少M0CRPC患者的数量。然而,它对患者预后的真正影响仍然是一个悬而未决的问题。此外，在CRPC患者中，PSMA配体PET存在一些灵敏度和特异性限制。由于其异质性，CRPC可能呈现肿瘤克隆的马赛克，其中一些可能是PSMA-/FDG+，反之亦然。同样，非特异性骨摄取（UBU）和在新血管生成血管中过度表达PSMA的第二原发性肿瘤（SNP）代表了潜在的特异性问题。集成的多示踪剂成像（PSMA配体和[18F]FDGPET）以及多学科讨论可以从精确医学的角度对每位患者进行最准确的评估。
