ABSTRACT
Objective:
The
incidence of
prostate cancer is increasing every year,and precision
diagnosis and
treatment can help reduce unnecessary
prostate punctures for
prostate cancer patients in the gray area.This study aims to investigate the diagnostic value of 18F-
prostate specific
membrane antigen(PSMA)imaging combined with
prostate specific antigen(PSA)-derived
indicators for gray zone
prostate cancer.
Methods:
A total of 107
patients who underwent 18F-PSMA
PET/CT imaging for suspicious
prostate cancer with tPSA of 4 to 10 μg/L(PSA gray zone)in a
hospital were retrospectively included,and were divided into a
prostate cancer group and a non-
prostate cancer group based on pathological findings.
Patients underwent PSA testing,18F-PSMA,and abdominal ultrasound,and age,tPSA,fPSA,f/tPSA,
prostate volume,PSA density(PSAD),maximum standardized uptake value(SUVmax),and
molecular imaging prostate specific
membrane antigen(miPSMA)score were compared between the 2 groups.Multivariate
logistic regression was used to analyze the influencing factors the
diagnosis of gray zone
prostate cancer.
Receiver operating characteristic(ROC)curves were constructed to evaluate the
efficacy of PSAD and SUVmax alone and in combination in diagnosing gray zone
prostate cancer.
Results:
The volume of the
prostate cancer group[42.00(34.00,58.00)cm3 vs 49.00(41.27,60.41)cm3]was smaller than that of the non-
prostate cancer group(Z=-2.376,P=0.017),and the PSAD[(0.18±0.06)μg/(L·cm3)vs 0.15±0.05 μg/(L·cm3)]and SUVmax[18.63(8.03,28.57)vs 9.33(5.90,13.52)]were higher than those in the non-
prostate cancer group(both P<0.05).The percentage of miPSMA score≥2 in the
prostate cancer group was higher than that in the non-
prostate cancer group(χ2=40.987,P<0.001).PSAD(OR= 22.154,95%CI 1.430 to 873.751,P=0.042)and SUVmax(OR=1.301,95%CI 1.034 to 1.678,P=0.009)were independent influential factors for the
diagnosis of
prostate cancer in the gray zone.The optimal cut-off values of PSAD and SUVmax were 0.22 μg/(L·cm3)and 8.02,respectively,and the AUCs for the
diagnosis of
prostate cancer in the gray zone alone and in combination were 0.628(95%CI 0.530 to 0.720,P<0.05)and 0.806(95%CI 0.718 to 0.876,P<0.05),0.847(95%CI 0.765 to 0.910,P<0.05),with sensitivities of 41.03%,76.92%,and 74.36%and specificities of 79.41%,89.71%,and 92.65%,respectively.
Conclusion:
PSAD and SUVmax are increased in
patients with gray zone
prostate cancer,and the combination of PSAD and SUVmax is of high value in diagnosing gray zone
prostate cancer.