<sup>18</sup>F-PSMA-1007 PET/CT对前列腺癌根治术后生化复发患者早期诊断评估和临床治疗决策影响的价值研究

李　曾; 吴　毅; 程祝忠; 陈　丽; 廖　洪; 毛　顿; 肖英明; 谢洪平; 李秀丽; 杨盛柯; 周术奎; 钟　磊; 陆　皓; 陈勇吉

doi:10.19401/j.cnki.1007-3639.2021.11.006

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¹⁸F-PSMA-1007 PET/CT对前列腺癌根治术后生化复发患者早期诊断评估和临床治疗决策影响的价值研究

论著 | 更新时间：2025-12-31

- ¹⁸F-PSMA-1007 PET/CT对前列腺癌根治术后生化复发患者早期诊断评估和临床治疗决策影响的价值研究
- The value of¹⁸F-PSMA-1007 PET/CT in the early diagnosis and clinical treatment of patients with biochemical recurrence after radical prostatectomy
- 中国癌症杂志 2021年31卷第11期页码：1081-1087
- 作者机构：
  
  四川省肿瘤医院·研究所，四川省癌症防治中心，电子科技大学医学院，泌尿外科,四川,成都
- 作者简介：
- 基金信息：
  
  四川省科技厅重点研发计划（2020YFS0421）。
- DOI：10.19401/j.cnki.1007-3639.2021.11.006
  中图分类号：
- 网络出版：2021-12-02，
  
  纸质出版：2021-12-02
- 稿件说明：
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李　曾, 吴　毅, 程祝忠, 陈　丽, 廖　洪, 毛　顿, 肖英明, 谢洪平, 李秀丽, 杨盛柯, 周术奎, 钟　磊, 陆　皓, 陈勇吉 .

李　曾, 吴　毅, 程祝忠, et al. The value of¹⁸F-PSMA-1007 PET/CT in the early diagnosis and clinical treatment of patients with biochemical recurrence after radical prostatectomy[J]. China Oncology, 2021, 31(11): 1081-1087.
李　曾, 吴　毅, 程祝忠, 陈　丽, 廖　洪, 毛　顿, 肖英明, 谢洪平, 李秀丽, 杨盛柯, 周术奎, 钟　磊, 陆　皓, 陈勇吉 . DOI： 10.19401/j.cnki.1007-3639.2021.11.006.

李　曾, 吴　毅, 程祝忠, et al. The value of¹⁸F-PSMA-1007 PET/CT in the early diagnosis and clinical treatment of patients with biochemical recurrence after radical prostatectomy[J]. China Oncology, 2021, 31(11): 1081-1087. DOI： 10.19401/j.cnki.1007-3639.2021.11.006.

摘要

背景与目的：

F-前列腺特异性膜抗原（prostate-specific membrane antigen，PSMA）-1007正电子发射计算机体层显像（positron emission tomography and computed tomography，PET/CT）是目前前列腺癌（prostate cancer，PCa）评估的先进分子影像学手段。探讨

F-PSMA-1007 PET/CT对PCa根治术（radical prostatectomy，RP）后生化复发（biochemical recurrence，BCR）患者临床复发和转移的早期检出率以及对临床治疗决策的影响。方法：总结分析2018年12月—2020年12月四川省肿瘤医院收治的行RP后BCR并行

F-PSMA-1007 PET/CT检查的51例PCa患者的资料，采用感兴趣区方法半定量计算分析肿瘤放射性摄取，以最大标准化摄取值（maximum standardized uptake value，SUV

max

）表示。评估其对BCR患者临床复发和转移灶［局部复发（前列腺床）、淋巴结转移（盆腔、腹膜后和膈上等）、骨转移和内脏转移（如肺）］的检出率，进一步分别比较不同前列腺特异性抗原（prostate-specific antigen，PSA）水平组间和原Gleason评分组间检出率的差异。结果：51例患者的中位年龄为66岁（52~80岁），初诊时血清中位PSA为35 ng/mL（6~224 ng/mL）。所有患者均为前列腺腺泡腺癌，其中1例伴导管内癌，1例伴导管腺癌，1例伴黏液腺癌，1例伴印戒样成分，1例伴神经内分泌分化。Gleason评分≤7分22例（43.14%），Gleason评分≥8分29例（56.86%）。BCR发生的中位时间为15个月（3~62个月），BCR时中位PSA为0.58 ng/mL（0.2~110.0 ng/mL），其中0.2 ng/mL≤PSA ＜ 0.5 ng/mL 21例（41.18%），0.5 ng/mL≤PSA ＜ 1.0 ng/mL12例（23.53%），1.0 ng/mL≤PSA ＜ 2.0 ng/mL 4例（7.84%），PSA≥2.0 ng/mL 14例（27.45%）。检查发现无临床局部复发或转移7例（13.73%），临床局部复发或转移44例（86.27%），其中9例（20.45%）前列腺

术区复发，28例（63.64%）不同部位淋巴结转移，31例（70.45%）骨转移，2例（4.55%）内脏转移，此外还有2例皮下结节转移及1例阴茎根部转移。所有复发或转移灶的中位SUV

max

为17.9（1.4~110.9），局部复发灶的中位SUV

max

为14.0（3.2~110.9），淋巴结转移灶的中位SUV

max

为10.2（2.0~90.1），骨转移灶的中位SUV max 为5.4（1.4~109.6）。0.2 ng/mL≤PSA ＜ 0.5 ng/mL组（21例）、0.5 ng/mL≤PSA ＜ 1.0 ng/mL组（12例）、1.0 ng/mL≤PSA ＜ 2.0 ng/mL组（4例）和PSA≥2.0 ng/mL组（14例）的复发或转移检出率分别为71.43%（15/21）、100.00%（12/12）、75.00%（3/4）和100.00%（14/14），不同PSA水平组间检出率差异无统计学意义（P＞0.05）。原Gleason评分≤7分组（22例）和Gleason评分≥8分组（29例）的复发或转移检出率分别为68.18%（15/22）和100.00%（29/29），不同Gleason评分组间检出率差异有统计学意义（P ＜ 0.05）。临床治疗方面，采用观察等待4例（7.84%），单纯内分泌治疗18例（35.29%），单纯挽救性放疗（salvage radiotherapy，SRT）2例（3.92%），内分泌治疗联合SRT 24例（47.06%），内分泌治疗联合多西他赛全身化疗1例（1.96%），挽救性盆腔淋巴结清扫术2例（3.92%），最终共有30例（58.82%）患者改变原临床治疗决策。结论：

F-PSMA-1007 PET/CT对RP后BCR患者临床复发或转移具有很好的早期诊断价值和效能，有利于此类患者的精准评估和制定最优的治疗方案，并显著影响临床治疗决策。

Abstract

Background and purpose:

F-prostate-specific membrane antigen (PSMA)-1007 positron emission tomography and computed tomography (PET/CT) is an advanced molecular imaging evaluation method for prostate cancer (PCa). This study aimed to explore the early detection rate of recurrence and metastasis of patients with biochemical recurrence (BCR) after radical prostatectomy (RP) by

F-PSMA-1007 PET/CT and its influence on clinical treatment decisions. Methods: From December 2018 to December 2020

the data of 51 PCa patients with BCR after RP by

F-PSMA-1007 PET/CT were summarized and analyzed. Radioactive uptake of tumors was calculated semi-quantitatively by region of interest method and expressed by the maximum standardized uptake value (SUV

max

). We assessed the detection rate of clinical recurrence and metastasis in BCR patients [local recurrence (prostatic bed)

lymph node metastasis (pelvic

retroperitoneal and diaphragmatic)

bone metastasis and visceral metastasis (such as lung)

]

and the difference in detection rate between prostate-specific anti

gen (PSA) groups and Gleason evaluation group was further compared respectively. Results: The median age of 51 patients was 66 years (52-80 years)

and the median PSA was 35 ng/mL (6-224 ng/mL) at the time of initial diagnosis. All of them were prostatic acinar adenocarcinoma

including 1 case with intraductal carcinoma

1 case with ductal adenocarcinoma

1 case with mucinous adenocarcinoma

1 case with signet ring-like component and 1 case with neuroendocrine differentiation. We found Gleason score ≤7 in 22 cases (43.14%) and Gleason score ≥ 8 in 29 cases (56.86%). The median time of BCR was 15 months (5-62 months)

and the median PSA was 0.58 ng/mL (0.20- 110.00 ng/mL)

including 21 (41.18%) cases with 0.20 ng/mL≤PSA ＜ 0.50 ng/mL

12 (23.53%) cases with 0.50 ng/mL≤PSA ＜ 1.00 ng/mL

4 (7.84%) cases with 1.00 ng/mL≤PSA ＜ 2.00 ng/mL and 14 (27.45%) cases with PSA≥2.00 ng/mL. There were 7 cases (13.73%) with no local recurrence or metastasis

and 44 cases (86.27%) with local recurrence or metastasis

including 9 cases (20.45%) with recurrence in the operative area of prostate

28 cases (63.64%) had lymph node metastasis at different sites

31 cases (70.45%) had bone metastasis

and 2 cases (4.55%) had visceral metastasis. In addition

there were 2 cases of subcutaneous nodule metastasis and 1 case of penile root metastasis. The median SUV

max

was 17.9 (1.4-110.9) for all recurrence or metastasis

14.0 (3.2-110.9) for local recurrence

10.2 (2.0-90.1) for lymph node metastasis

and 5.4 (1.4-109.6) for bone metastasis. The detection rates of recurrence or metastasis were 71.43% (15/21)

100.00% (12/12)

75.00% (3/4) and 100.00% (14/14)

respectively

in the groups with 0.20 ng/mL≤PSA ＜ 0.50 ng/mL (21 cases)

0.50 ng/mL≤PSA ＜ 1.00 ng/mL (12 cases)

1.00 ng/mL≤PSA ＜ 2.00 ng/mL (4 cases) and PSA≥2.00 ng/mL (14 cases)

and there was no statistically significant difference in the detection rate between groups with different PSA levels (P＞0.05). The recurrence or metastasis detection rates of original Gleason sc

ore ≤7 group (22 cases) and Gleason score ≥8 group (29 cases) were 68.18% (15/22) and 100.00% (29/29)

respectively

and there were statistically significant differences in the detection rate between groups with different Gleason scores (P ＜ 0.05). In clinical treatment

4 cases (7.84%) were treated by observation

18 cases (35.29%) by endocrinotherapy alone

2 cases (3.92%) by salvage radiotherapy (SRT) alone

24 cases (47.06%) by endocrinotherapy combined with SRT

1 case (1.96%) by endocrinotherapy combined with docetaxel systemic chemotherapy

and 2 cases (3.92%) by salvage pelvic lymphadenectomy. Conclusion:

F-PSMA-1007 PET/CT has a good value and efficacy in early diagnosis of clinical recurrence or metastasis of BCR patients after RP

which is conducive to accurate evaluation and optimal treatment plan for such patients

and significantly affects clinical treatment decisions.

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The value of18F-PSMA-1007 PET/CT in the early diagnosis and clinical treatment of patients with biochemical recurrence after radical prostatectomy

DOI：10.19401/j.cnki.1007-3639.2021.11.006

摘要

Abstract

关键词

Keywords

references

¹⁸F-PSMA-1007 PET/CT对前列腺癌根治术后生化复发患者早期诊断评估和临床治疗决策影响的价值研究

The value of¹⁸F-PSMA-1007 PET/CT in the early diagnosis and clinical treatment of patients with biochemical recurrence after radical prostatectomy