Purpose

To assess the diagnostic performance of prostate specific membranous antigen (PSMA) positron emission tomography/computed tomography (PET/CT) imaging to localize primary prostate cancer (PCa) in men with persistent elevated prostate-specific antigen (PSA) levels and previous prostate biopsies that were negative for PCa.

Methods

In this study, 34 men with persistently elevated PSA-levels, previous negative for PCa biopsies and who subsequently underwent diagnostic PSMA-PET/CT imaging were retrospectively evaluated. Men were divided into 3 groups: 1. 12 men with a previous negative mpMRI scan (PI-RADS 1-2) 2. 17 men with a positive mpMRI scan (PI-RADS 3-5), but negative MRI-targeted biopsies and 3. Four men in whom mpMRI was contraindicated. If PSMA-avid lesions were seen, patients underwent 2-4 cognitive targeted biopsies in combination with systematic biopsies. The detection rate of PSMA-PET/CT for PCa, and the accuracy of (possible) targeted biopsies were calculated.

Results

Included men had a median PSA-level of 22.8 ng/mL (Interquartile Range 15.6–30.0) at the time of PSMA-PET/CT. Elevated PSMA-ligand uptake in the prostate suspicious for PCa was observed in 22/34 patients (64.7%). In 18/22 patients (54.5%), PSMA-targeted prostate biopsies were performed. In 3/18 patients (16.6%), the targeted biopsies showed International Society of Urological Pathology (ISUP) score 1–2 PCa. The other men had inflammation or benign findings after histopathological examination of the biopsy cores.

Conclusion

In this study, the clinical value of PSMA-PET/CT for patients with an elevated PSA-level, and negative for PCa biopsies was low. Only very few men were diagnosed with PCa, and no clinically significant PCa was found.

中文翻译：

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确定 PSMA-PET/CT 成像对持续高前列腺特异性抗原水平和前列腺活检阴性患者的诊断价值

目的

评估前列腺特异性膜抗原 (PSMA) 正电子发射断层扫描/计算机断层扫描 (PET/CT) 成像在前列腺特异性抗原 (PSA) 水平持续升高和既往前列腺活检的男性中定位原发性前列腺癌 (PCa) 的诊断性能对 PCa 不利。

方法

在这项研究中，回顾性评估了 34 名 PSA 水平持续升高、先前对 PCa 活检呈阴性以及随后接受诊断性 PSMA-PET/CT 成像的男性。男性被分为 3 组：1. 12 名先前 mpMRI 扫描阴性 (PI-RADS 1-2) 的男性 2. 17 名 mpMRI 扫描阳性 (PI-RADS 3-5) 但 MRI 靶向活检阴性的男性和3. 四名禁用 mpMRI 的男性。如果发现 PSMA-avid 病变，患者接受 2-4 次认知靶向活检并结合系统活检。计算 PSMA-PET/CT 对 PCa 的检出率和（可能的）靶向活检的准确性。

结果

纳入的男性在 PSMA-PET/CT 时的中位 PSA 水平为 22.8 ng/mL（四分位距 15.6-30.0）。在 22/34 名患者 (64.7%) 中观察到疑似 PCa 的前列腺中 PSMA 配体摄取升高。在 18/22 名患者 (54.5%) 中，进行了 PSMA 靶向前列腺活检。在 3/18 患者 (16.6%) 中，靶向活检显示国际泌尿病理学会 (ISUP) 评分为 1-2 PCa。其他男性在活检核心组织病理学检查后有炎症或良性发现。

结论

在这项研究中，PSMA-PET/CT 对于 PSA 水平升高且 PCa 活检阴性的患者的临床价值较低。只有极少数男性被诊断出患有 PCa，并且没有发现有临床意义的 PCa。