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Abstract：
Background Intravenous prostate-specific membrane antigen (PSMA)-targeted radioligand therapy improves survival in men with metastatic castration-resistant prostate cancer. Yet, the impact of selective prostatic arterial administration on primary tumor uptake is unclear. Purpose To compare gallium 68 (68Ga)-PSMA-11 uptake using dynamic PET/CT in prostatic tumoral volumes of interest (VOIs) during intravenous and selective prostatic arterial infusions for individuals with untreated, high-risk prostate cancer. Materials and Methods In this prospective, intraindividual comparative study conducted at an academic medical center, five men aged 58, 61, 64, 66, and 68 years with treatment-naive prostate cancer were enrolled between January 2022 and February 2023 and underwent two dynamic 68Ga-PSMA-11 PET/CT examinations 1 week apart. During the first examination, the radiotracer was administered intravenously. During the second administration, the radiotracer was delivered into either the right or left prostatic artery through an angiographically placed microcatheter. The primary outcome was maximum standardized uptake value (SUVmax) in prostatic tumoral VOIs. The secondary outcomes included mean SUV (SUVmean) in prostatic tumoral VOIs and area under the SUVmean curves (AUC). Longitudinal mixed-effects models were used to compare dynamic SUVmax and SUVmean time-activity curves (TACs), and paired t tests were used for the remaining data. Results The mean SUVmax within tumoral VOIs was 14 (range, 3-43) for venous sessions and 938 (range, 460-1436) for arterial sessions (P = .008). The SUVmean within VOIs was greater during arterial sessions (P < .001) overall and 46-fold and 19-fold greater at peak uptake and final time points, respectively. The mean AUC was greater on arterial TACs than on venous TACs at 14600 SUV × min (range, 8353-20025 SUV × min) and 240 SUV × min (range, 69-622 SUV × min), respectively (P = .002). Conclusion Selective prostatic arterial infusion resulted in greater 68Ga-PSMA-11 tumoral SUV than intravenous infusion. Further study of local-regional, intra-arterial delivery of a PSMA-targeted theranostic agent is warranted in high-risk prostate cancer. ClinicalTrials.gov identifier: NCT04976257 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Civelek in this issue.
摘要：
背景：静脉前列腺特异性膜抗原（PSMA）靶向放射性配体治疗可改善转移性去势抵抗性前列腺癌患者的生存率。然而，选择性前列腺动脉给药对原发性肿瘤摄取的影响尚不清楚.目的比较未经治疗的个体在静脉和选择性前列腺动脉输注期间使用动态PET/CT在前列腺肿瘤感兴趣体积（VOIs）中的镓68（68Ga）-PSMA-11摄取，高危前列腺癌.材料和方法在这个前瞻性的，在学术医学中心进行的个体内比较研究，在2022年1月至2023年2月期间,纳入了5名年龄分别为58,61,64,66和68岁的未接受过治疗的前列腺癌患者,并间隔1周接受了2次动态68Ga-PSMA-11PET/CT检查.在第一次考试中,放射性示踪剂是静脉给药的.在第二次管理期间，放射性示踪剂通过血管造影微导管进入右或左前列腺动脉.主要结果是前列腺肿瘤VOI的最大标准化摄取值（SUVmax）。次要结果包括前列腺肿瘤VOI的平均SUV（SUVmean）和SUVmean曲线下面积（AUC）。纵向混合效应模型用于比较动态SUVmax和SUVmean时间-活动曲线（TAC），其余数据采用配对t检验。结果肿瘤VOIs内的平均SUVmax为14(范围，3-43）用于静脉会话和938（范围，460-1436）用于动脉治疗（P=.008）。总动脉期（P<.001）期间VOIs内的SUV平均值较大，在摄取峰值和最终时间点分别为46倍和19倍，分别。在14600SUV×min时，动脉TAC的平均AUC大于静脉TAC（范围，8353-20025SUV×min）和240SUV×min（范围，69-622SUV×min)，分别(P=0.002)。结论与静脉输注相比，选择性前列腺动脉输注导致68Ga-PSMA-11肿瘤SUV更大。进一步研究地方-区域，在高危前列腺癌患者中,有必要动脉内递送靶向PSMA的治疗诊断药物.ClinicalTrials.gov标识符：NCT04976257©RSNA，2024补充材料可用于本文。另见本期Civelek的社论。
