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具有PI-RADS评分5的男性的阴性活检组织学:PSMA PET/CT评估是否有用?

Pietro Pepe¹, Ludovica Pepe², Michele Pennisi³

¹Urology Unit, Cannizzaro Hospital, Catania. piepepe@hotmail.com.

Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica

|June 27, 2024

概括

前列腺特异性膜抗原正子发射断层扫描/计算机断层扫描 (PSMA PET/CT) 可以准确地识别PI-RADS评分为5的男性的侵袭性前列腺癌,初始活检结果为阴性. 这种成像模式有助于避免不必要的活检,并指导临床管理.

科学领域:

在瘤学瘤学.
放射学放射学是一门学科.
泌尿器科泌尿器科泌尿器科泌尿器科

背景情况:

前列腺癌的诊断依赖于多参数MRI (mpMRI) 和活检.
具有PI-RADS评分5和阴性活检的男性需要进一步评估.
在这种特定的临床场景中,PSMA PET/CT的准确性需要评估.

研究的目的:

为了评估PSMA PET/CT在PI-RADS评分为5和前列腺活检阴性男性的诊断准确性.
确定PSMA PET/CT在鉴定临床显著前列腺癌 (csPCa) 中的实用性.

主要方法:

对180名PI-RADS评分为5的男性进行了回顾性分析,这些男性接受了系统性加上mpMRI/TRUS活检.
25名带有阴性活检的患者接受了随访,包括PSA,PSA密度,mpMRI和68Ga-PSMA PET/CT.
标准化吸收值最大值 (SUVmax) 被记录为PSMA PET/CT.

主要成果:

96%的阴性活检患者显示PSA和PSA密度下降,PI-RADS得分降至<3.
这些患者的SUVmax中位数为7.5.5.
一名患者 (4%) 的PSA升高,证实PI-RADS 5,高SUVmax (32) 和格里森得分9 PCa在重复活检.

结论:

密切跟踪和PSMA PET/CT帮助检测PI-RADS 5和阴性组织学男性遗漏的csPCa.
根据PSMA PET/CT协议与mpMRI降级 (PI-RADS<3) 降低了错过侵袭性前列腺癌的风险.

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