Effect of 18F-FDG combined with 18F-PSMA-1007 PET/CT on TNM staging and clinical treatment decision of prostate cancer / 中华核医学与分子影像杂志

ABSTRACT

Objective:To investigate the effect of 18F-FDG combined with 18F-prostate specific membrane antigen (PSMA)-1007 PET/CT on TNM staging and clinical treatment decision of patients with prostate cancer. Methods:Clinical data and PET/CT images of 31 patients (age (69.9±9.2) years) with prostate cancer who underwent PET/CT imaging with 18F-FDG and 18F-PSMA-1007 (dual-tracer imaging) in the Second Xiangya Hospital of Central South University from June 2020 to March 2022 were retrospectively analyzed. Paired χ2 test was used to compare the diagnostic efficacy of 18F-FDG, 18F-PSMA-1007 and combined imaging for diagnosing primary prostate cancer, regional lymph node metastases and distant metastases, and to analyze the influence of combined imaging on clinical treatment decision. Results:There were 282 metastatic sites in 31 patients, including 46 regional lymph node metastases in 13 patients and 236 distant metastases in 15 patients. The detection rates of 18F-PSMA-1007 PET/CT and combined imaging for primary lesions were higher than the detection rate of 18F-FDG PET/CT (100%(31/31), 100%(31/31) vs 64.5%(20/31); χ2=13.37, P<0.001). Based on analysis of patients, the detection rates of 18F-PSMA-1007 PET/CT and combined imaging for regional lymph node metastases were higher than the detection rate of 18F-FDG PET/CT (12/13, 12/13 vs 6/13; χ2=4.51, P=0.034), and the 3 detection rates for distant metastases were also significantly different (15/15, 15/15 vs 10/15; χ2=6.00, P=0.042). Based on analysis of lesions, the detection rates of 18F-PSMA-1007 PET/CT and combined imaging for regional lymph node metastases were higher than the detection rate of 18F-FDG PET/CT (95.7%(44/46), 97.8%(45/46) and 45.7%(21/46); χ2 values: 25.37-49.56, all P<0.001). The detection rate of combined imaging for distant metastases was higher than that of 18F-FDG or 18F-PSMA-1007 PET/CT alone (96.2%(227/236) vs 68.6%(162/236), 58.9%(139/236)); and the detection rate of 18F-FDG PET/CT was higher than that of 18F-PSMA-1007 PET/CT ( χ2 values: 4.85-94.22, all P<0.05). Clinical treatment decisions in 10 patients (32.3%, 10/31) were changed based on the results of combined imaging. Conclusion:For prostate cancer with suspected distant metastases, 18F-FDG and 18F-PSMA-1007 dual-tracer PET/CT imaging can improve staging and guide clinical treatment decisions.