This bicentric, retrospective analysis investigated the efficacy of PET/CT with a novel theranostic prostate-specific membrane antigen (PSMA)--targeting ligand, ¹⁸F-rhPSMA-7, in patients with biochemical recurrence (BCR) of prostate cancer after curative-intent primary radiotherapy. Methods: Datasets from patients with BCR of prostate cancer after external-beam radiation therapy or brachytherapy who underwent ¹⁸F-rhPSMA-7 PET/CT at either Technical University Munich or Ludwig-Maximilians-University Munich were retrospectively reviewed by experienced nuclear medicine physicians and radiologists at both centers. The median injected activity was 299 MBq (range, 204–420 MBq), and the median uptake time was 77 min (range, 46–120 min). All lesions suggestive of recurrent prostate cancer were noted. Detection rates were correlated with patients’ prostate-specific antigen (PSA) level, primary Gleason score, and prior use of androgen-deprivation therapy (ADT). Results: Ninety-seven patients were included (65 at Technical University Munich and 32 at Ludwig-Maximilians-University Munich). The median prescan PSA was 4.19 ng/mL (range, 0.1–159 ng/mL). The primary Gleason score was ≤6 in 19 patients, 7 in 25, ≥8 in 33, and unknown in 20. Thirty patients received ADT in the 6 mo preceding PET/CT. ¹⁸F-rhPSMA-7 identified lesions in 91 of 97 (94%) patients. Detection rates stratified by PSA were 88% (22/25), 97% (30/31), 90% (19/21), and 100% (20/20) for a PSA of <2, 2–<5, 5–<10, and ≥10 ng/mL, respectively. Detection rates in the subgroup of patients not meeting the Phoenix criteria for BCR were 80% (4/5), 90% (9/10), 100% (4/4), and 83% (5/6) for a PSA of <0.5, 0.5–<1, 1–<1.5, and 1.5–2 ng/mL, respectively. There were no significant differences in detection rates between patients with and without prior ADT (100% vs. 91%, P = 0.173) or patients with a Gleason score of ≤7 and a Gleason score of ≥8 (98% vs. 91%, P = 0.316).¹⁸F-rhPSMA-7 revealed local recurrence in 80% (78/97); pelvic lymph node metastases in 38% (37/97); retroperitoneal and supradiaphragmatic lymph node metastases in 9% (9/97) and 4% (4/97), respectively; bone metastases in 27% (26/97); and visceral metastases in 3% (3/97). In the subgroup of patients with a PSA of <2 ng/mL above nadir, local recurrence occurred in 76% (19/25) and pelvic lymph node metastases in 36% (9/25). Conclusion: ¹⁸F-rhPSMA-7 PET/CT demonstrates high detection rates in prostate cancer patients with BCR after primary radiation therapy, even at low PSA values. Its diagnostic efficacy is comparable to published data for other PSMA ligands.

这项双中心、回顾性分析研究了 PET/CT 与新型治疗诊断前列腺特异性膜抗原 (PSMA) 靶向配体¹⁸ F-rhPSMA-7 在治疗后前列腺癌生化复发 (BCR) 患者中的疗效 -意向性初级放疗。方法：来自接受了¹⁸次外束放射治疗或近距离放射治疗的前列腺癌 BCR 患者的数据慕尼黑工业大学或路德维希马克西米利安大学慕尼黑分校的 F-rhPSMA-7 PET/CT 由两个中心的经验丰富的核医学医师和放射科医师进行了回顾性审查。中位注射活性为 299 MBq（范围，204-420 MBq），中位摄取时间为 77 分钟（范围，46-120 分钟）。记录所有提示复发性前列腺癌的病变。检出率与患者的前列腺特异性抗原 (PSA) 水平、初级 Gleason 评分和先前使用的雄激素剥夺疗法 (ADT) 相关。结果：包括 97 名患者（慕尼黑工业大学 65 名，慕尼黑路德维希-马克西米利安大学 32 名）。扫描前 PSA 的中位数为 4.19 ng/mL（范围 0.1-159 ng/mL）。19 名患者的主要 Gleason 评分≤6，25 名患者为 7 名，33 名患者≥8 名，20 名患者未知。30 名患者在 PET/CT 之前的 6 个月内接受了 ADT。¹⁸F-rhPSMA-7 在 97 名患者中的 91 名 (94%) 中发现了病变。对于 PSA <2、2–<5、分别为 5–<10 和 ≥10 ng/mL。不符合 Phoenix BCR 标准的患者亚组的 PSA 检出率为 80% (4/5)、90% (9/10)、100% (4/4) 和 83% (5/6)分别为 <0.5、0.5–<1、1–<1.5 和 1.5–2 ng/mL。有和没有既往 ADT 的患者（100% 对 91%，P = 0.173）或 Gleason 评分≤7 和 Gleason 评分≥8 的患者（98% 对 91%）的检出率没有显着差异, P = 0.316)。¹⁸F-rhPSMA-7 显示 80% (78/97) 局部复发；盆腔淋巴结转移 38% (37/97)；腹膜后和膈上淋巴结转移分别为 9% (9/97) 和 4% (4/97)；27% (26/97) 发生骨转移；3% (3/97) 发生内脏转移。在 PSA 高于最低值 <2 ng/mL 的患者亚组中，76% (19/25) 发生局部复发，36% (9/25) 发生盆腔淋巴结转移。结论： ¹⁸ F-rhPSMA-7 PET/CT 表明前列腺癌患者在初次放射治疗后的 BCR 检出率很高，即使在 PSA 值较低的情况下也是如此。其诊断功效可与其他 PSMA 配体的已发表数据相媲美。