前列腺特异性膜抗原PET/CT对减少前列腺癌过度穿刺活检的应用价值  

Clinical Application of Prostate-specific Membrane Antigen PET/CT for Reducing Unnecessary Biopsies in Prostate Cancer

作　　者：张继燊 谢玉洁 杨婷[2] 焦举[2] 何朝辉[1] ZHANG Jishen;XIE Yujie;YANG Ting;JIAO Ju;HE Zhaohui(Department of Urology,The Eighth Affiliated Hospital of Sun Yat-sen University,Shenzhen 518033,China;Department of Nuclear Medicine,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第八医院泌尿外科,广东深圳518033 [2]中山大学附属第三医院核医学科,广东广州510630

出　　处：《中山大学学报(医学科学版)》2025年第2期311-317,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81871417)。

摘　　要：【目的】评估前列腺特异性膜抗原(PSMA)PET/CT在前列腺穿刺活检筛查中的应用效果,提出基于PSMA PET/CT检查的前列腺癌穿刺活检策略。【方法】回顾性分析2020年1月至2023年12月期间155例可疑前列腺癌患者穿刺活检前的PSMA PET/CT图像和临床病理资料。采用PRIMARY评分作为PSMA PET/CT诊断前列腺癌的标准化评估方法,比较不同PRIMARY评分筛选前列腺穿刺患者的活检阳性率、漏诊患者比例及避免活检患者比例。使用ROC曲线分析PSA及其衍生指标,选出最适合与PRIMARY评分联合应用的补充筛查指标,评估两者联用对降低漏诊患者比例的效果。【结果】PRIMARY评分1~5分的病例中前列腺的患者比例分别为15.8%(3/19),17.1%(7/41),50%(12/24),95.2%(20/21),98%(49/50)。以PRIMARY评分3~5分作为筛选策略的活检阳性率为85.3%,避免活检患者比例为38.7%,漏诊率为11%。以PSA密度>0.15 ng/(mL·cm³)作为辅助筛选标准,能有效检出PRIMARY评分1~2分病例中的前列腺癌患者,与PRIMARY评分3~5分筛选策略联合应用,可使活检漏诊率降低至2.2%。【结论】本研究提出一种新的PSMA PET/CT应用于可疑前列腺癌患者穿刺活检的筛选策略,即对PRIMARY评分3~5分或PRIMARY评分1~2分但PSA密度>0.15 ng/(mL·cm³)的患者进行活检。该综合策略能够有效避免不必要的活检,同时显著降低漏诊率。【Objective】To evaluate the application of prostate-specific membrane antigen(PSMA)PET/CT in prostate biopsy screening,and propose effective strategies for prostate biopsy decision making based on PSMA PET/CT detection.【Methods】A retrospective analysis was conducted on PSMA PET/CT imaging and clinical pathological data from 155 patients with suspected prostate cancer between January 2020 and December 2023.PRIMARY score was used as the standardized evaluation method for PSMA PET/CT in the diagnosis of prostate cancer.And compared the positive prostate biopsy rates,missed diagnosis rates and biopsy reduction rates were compared regarding different PRIMARY scores.Receiver operating characteristic(ROC)curves were used to analyze prostate-specific antigen(PSA)and its derived parameters and identify the most suitable supplementary screening indicators for combined use with the PRIMARY score.【Results】Among patients with PRIMARY scores of 1 to 5,the proportions of patients diagnosed with prostate cancer were 15.8%(3/19),17.1%(7/41),50%(12/24),95.2%(20/21)and 98%(49/50),respectively.Using PRIMARY score of 3-5 as the biopsy screening strategy resulted in a positive prostate biopsy rate of 85.3%and biopsy reduction rate of 38.7%,but a missed diagnosis rate of 11%.PSA density>0.15 ng/(mL·cm³)was selected as a supplementary screening criterion to detect prostate cancer from patients with PRIMARY scores of 1-2.The combined application of the above two screening criteria reduced the missed diagnosis rate to 2.2%.【Conclusion】This study proposes a novel biopsy screening strategy for suspected prostate cancer patients using PSMA PET/CT,that is,a PRIMARY score of 3-5 or a PRIMARY score of 1-2 but PSA density>0.15 ng/(mL·cm³),which can effectively avoid unnecessary biopsies and significantly reduce the missed diagnosis rate.

关 键 词：前列腺穿刺 前列腺癌 PET/CT 前列腺特异膜抗原 前列腺特异抗原密度 

分 类 号：R737.25[医药卫生—肿瘤]