背景:前列腺特异性膜抗原(PSMA)是一种II型跨膜糖蛋白,在大多数患有前列腺腺癌(PCa)的患者中在肿瘤细胞表面过表达。然而,PSMA表达也已在各种实体瘤的新形成血管的内皮细胞中得到证实,提示PSMA在新血管生成中的作用。在这种情况下,镓-68(68Ga)或氟-18(18F)标记的PSMA正电子发射断层扫描(PET)可能在PCa以外的肿瘤中发挥作用,通常采用针对不同途径的其他放射性药物进行评估。这篇综述旨在研究PSMA-PET在非前列腺肿瘤中与其他放射性药物(尤其是[18F]FDG)相比的检出率,以确定可能从使用这种不诊断药物中受益的患者。
方法:我们在三个不同的数据库上进行了书目搜索,直到2024年2月,使用以下术语:\“正电子发射断层扫描\”,\"PET\",\"PET/CT\",“前列腺特异性膜抗原”,\"PSMA\",\"非前列腺\",“不是前列腺癌”,“实体瘤”,\"FDG\",“氟脱氧葡萄糖”,\"FAPi\",\"FET\",\"MET\",\"DOPA\",\"胆碱\",\"FCH\",\"FES\",\"DOTATOC\",\"DOTANOC\",和“DOTATATE”。仅包括至少10名患者的英文原始文章。
结果:在总共120篇文章中,本研究仅纳入25篇将PSMA与其他放射性示踪剂进行比较的原创文章.主要证据是在肾细胞癌,与[18F]FDGPET/CT相比,PSMA显示出更高的检出率,对患者管理有影响。PSMAPET还可以改善对其他实体的评估,比如神经胶质瘤,在定义早期新血管生成的区域。需要进一步的数据来评估PSMA-PET在三阴性乳腺癌中作为一种新的治疗血管靶标的潜在作用。最后,PSMA-PET的应用不清楚包括甲状腺和胃肠道肿瘤。
结论:本综述显示了PSMA标记的PET/CT在PCa以外的实体瘤中的潜在用途。强调其相对于其他放射性药物(主要是[18F]FDG)的价值。具有更大样本量的前瞻性临床试验对于进一步研究这些可能的临床应用至关重要。
BACKGROUND: Prostate-specific membrane antigen (PSMA) is a type II transmembrane glycoprotein overexpressed on the surface of tumor cells in most of the patients affected by prostate adenocarcinoma (PCa). However, PSMA expression has also been demonstrated in the endothelial cells of newly formed vessels of various solid tumors, suggesting a role for PSMA in neoangiogenesis. In this scenario, gallium-68 (68Ga) or fluoro-18 (18F)-labeled PSMA positron emission tomography (PET) may play a role in tumors other than PCa, generally evaluated employing other radiopharmaceuticals targeting different pathways. This review aims to investigate the detection rate of PSMA-PET compared to other radiopharmaceuticals (especially [18F]FDG) in non-prostate tumors to identify patients who may benefit from the use of such a theragnostic agent.
METHODS: We performed a bibliographic search on three different databases until February 2024 using the following terms: \"positron emission tomography\", \"PET\", \"PET/CT\", \"Prostate-specific membrane antigen\", \"PSMA\", \"non-prostate\", \"not prostate cancer\", \"solid tumor\", \"FDG\", \"Fluorodeoxyglucose\", \"FAPi\", \"FET\", \"MET\", \"DOPA\", \"choline\", \"FCH\", \"FES\", \"DOTATOC\", \"DOTANOC\", and \"DOTATATE\". Only original articles edited in English with at least 10 patients were included.
RESULTS: Out of a total of 120 articles, only 25 original articles comparing PSMA with other radiotracers were included in this study. The main evidence was demonstrated in renal cell carcinoma, where PSMA showed a higher detection rate compared to [18F]FDG PET/CT, with implications for patient management. PSMA PET may also improve the assessment of other entities, such as gliomas, in defining regions of early neoangiogenesis. Further data are needed to evaluate the potential role of PSMA-PET in triple-negative breast cancer as a novel therapeutic vascular target. Finally, unclear applications of PSMA-PET include thyroid and gastrointestinal tumors.
CONCLUSIONS: The present review shows the potential use of PSMA-labeled PET/CT in solid tumors beyond PCa, underlining its value over other radiopharmaceuticals (mainly [18F]FDG). Prospective clinical trials with larger sample sizes are crucial to further investigate these possible clinical applications.