A prospective, multi-centre trial of PSMA-PET compared to FDG-PET for staging of newly diagnosed high risk prostate cancer.

IF 3.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

EJNMMI Research Pub Date : 2025-07-24 DOI:10.1186/s13550-025-01265-z

Matthew J Roberts, Natasha A Roberts, Anita Pelecanos, John W Yaxley, Simon J D Harley, Amila R Siriwardana, Karla Cullen, Marita Prior, Karen Lindsay, Ian Vela, Anna Kuchel, Nattakorn Dhiantravan, Paul Thomas, David A Pattison

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引用次数: 0

Abstract

Background: Despite being a potentially attractive alternative molecular imaging modality due to wider availability and association with lethal disease in advanced prostate cancer, the role of fluorodeoxyglucose (FDG)- positron emission tomography (PET) at initial diagnosis compared to Prostate Specific Membrane Antigen (PSMA) PET is yet to be accurately determined. The aim of this study was to evaluate the additive benefit of FDG PET to PSMA PET in patients with newly diagnosed, high risk prostate cancer.

Results: A prospective trial conducted across three sites between October-2021 and January-2023 recruited 32 participants with high risk (EAU classification) prostate cancer staged with PSMA PET-CT. FDG PET-CT was acquired centrally and reported with a standardised template. Median age was 69 years, median PSA was 14 ug/L, and most had PI-RADS 5 scores (59%) and ISUP Grade Group 5 tumours (66%). Overall, FDG-PET did not detect any additional definite/probable metastasis according to physician interpretation. All tumours showed PSMA avidity and higher stage was observed per PSMA-PET in 5 participants. No FDG uptake at the primary tumour occurred in 34% of participants. FDG-PET did not result in a change in management for any participant. PSA remission rates were lower in patients with stage ≥ 3 tumours on MRI (60% vs 94%, p = 0.04). Patient reported outcomes (PROs) were largely stable throughout the study.

Conclusions: FDG-PET did not provide additive staging information above PSMA-PET or alter management for newly diagnosed high-risk prostate cancer patients.

Trial registration number: ANZCTR ACTRN12621001185853. Registered 03-09-2021. Available at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382299.

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PSMA-PET与FDG-PET对新诊断的高危前列腺癌分期的前瞻性多中心试验

背景：尽管氟脱氧葡萄糖(FDG)-正电子发射断层扫描（PET）在初始诊断中的作用与前列腺特异性膜抗原（PSMA） PET相比，作为一种潜在的有吸引力的替代分子成像方式，在晚期前列腺癌中具有更广泛的可用性和与致死性疾病的相关性，但尚未准确确定。本研究的目的是评估FDG PET与PSMA PET在新诊断的高危前列腺癌患者中的附加益处。结果：一项前瞻性试验于2021年10月至2023年1月在三个地点进行，招募了32名高风险（EAU分类）前列腺癌患者，PSMA PET-CT分期。FDG PET-CT集中采集，用标准化模板报告。中位年龄为69岁，中位PSA为14 ug/L，大多数PI-RADS 5评分（59%）和ISUP分级5组肿瘤（66%）。总的来说，根据医生的解释，FDG-PET未检测到任何其他明确/可能的转移。所有肿瘤均显示PSMA亲和性，5名参与者的PSMA- pet观察到更高的分期。34%的参与者在原发肿瘤处没有FDG摄取。FDG-PET未导致任何参与者的管理改变。MRI显示≥3期肿瘤患者的PSA缓解率较低（60% vs 94%, p = 0.04）。患者报告的结果（PROs）在整个研究过程中基本稳定。结论：FDG-PET不能提供PSMA-PET以上的附加分期信息，也不能改变新诊断的高危前列腺癌患者的治疗。试验注册号：ANZCTR ACTRN12621001185853。注册03-09-2021。可在https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382299获得。

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来源期刊

EJNMMI Research RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING&nb-

CiteScore

5.90

自引率

3.10%

发文量

审稿时长

13 weeks

期刊介绍： EJNMMI Research publishes new basic, translational and clinical research in the field of nuclear medicine and molecular imaging. Regular features include original research articles, rapid communication of preliminary data on innovative research, interesting case reports, editorials, and letters to the editor. Educational articles on basic sciences, fundamental aspects and controversy related to pre-clinical and clinical research or ethical aspects of research are also welcome. Timely reviews provide updates on current applications, issues in imaging research and translational aspects of nuclear medicine and molecular imaging technologies. The main emphasis is placed on the development of targeted imaging with radiopharmaceuticals within the broader context of molecular probes to enhance understanding and characterisation of the complex biological processes underlying disease and to develop, test and guide new treatment modalities, including radionuclide therapy.