The value of 18F-PSMA-1007 PET /CT in detecting the risk of metastasis in patients newly diagnosed with prostate cancer / 西安交通大学学报(医学版)

【Objective】 To investigate the diagnostic efficiency of 18F-PSMA-1007 PET/CT in assessing the metastasis of newly diagnosed prostate cancer （PC）， and evaluate its relationship with clinical risk classification. 【Methods】 The clinical data of 257 newly diagnosed PC patients who underwent 18F-PSMA-1007 PET/CT between March 2019 and April 2021 were retrospectively reviewed in this study. All images were interpreted by two senior PET/CT diagnostic specialists. According to the D’Amico risk classification， the patients were divided into low-， intermediate- and high-risk groups. According to Gleason score （GS）， the patients were divided into GS≤6， GS=7， and GS≥8 groups. According to the level of serum total prostate-specific antigen （tPSA）， the patients were divided into <10 ng/mL， 10-20 ng/mL， and >20 ng/mL groups. Finally， in the groups with D’Amico risk classification， the subgroups were divided according to tPSA level and GS， and the differences of 18F-PSMA-1007 PET/CT in the detection of metastasis were compared among the subgroups. 【Results】 A total of 257 patients were enrolled with a median tPSA 16.34 （3.38-783.12） ng/mL and median Gleason score （GS） 8 （range： 6-10）. There were 10 （3.89%）， 36 （15.01%）， and 211（80.10%） PC patients in the low-， intermediate-， and high-risk groups， respectively. The rate of metastasis in high-risk group， GS ≥ 8 group， and tPSA >20 ng/mL group was 45.02%， 46.50%， and 47.02%， respectively. The rate of metastasis in low-risk group， GS ≤6 group and tPSA <10 ng/mL group was 0， 8.82%， and 15.63%， respectively. When tPSA <10 ng/mL， the rate of metastasis in low-risk group （0） was lower than that in high-risk group （33.33%）. When tPSA was 10-20 ng/mL， the rate of metastasis in intermediate-risk group （7.69%） was lower than that in high-risk group （38.71%）. When GS ≤6， the rate of metastasis in low-risk group （0） was lower than that in high-risk group （38.71%）. 【Conclusion】 The detection rate of metastasis in patients with newly diagnosed prostate cancer by 18F-PSMA-1007 PET/CT is positively correlated with GS， preoperative tPSA level， and D’Amico risk grade.

The value of 18F-PSMA PET/CT imaging in detecting bone metastasis of prostate cancer / 西安交通大学学报(医学版)

【Objective】 To compare the detection efficiency of 99mTc-MDP SPECT and PSMA PET/CT in detecting bone metastases in patients with prostate cancer. 【Methods】 We retrospectively collected data of 83 patients diagnosed with prostate cancer in The First Affiliated Hospital of Xi’an Jiaotong University from March 2019 to July 2020, concurrent with 99mTc-MDP SPECT and 18F-PSMA PET/CT whole body imaging in the same period. Two nuclear medicine physicians attending a double-blind interpretation compared whether the patients with bone metastases detected by two imaging methods under different PSA levels and different Gleason scores, and further analyzed the location and number of inconsistent bone metastases as well as the ability of PET/CT to detect metastatic lesions other than bone. 【Results】 Compared with 99mTc-MDP SPECT, 18F-PSMA PET/CT could detect more prostate cancer patients with bone metastases (P<0.001). When TPSA<10 ng/mL or >20 ng/mL, the detection rate of PET/CT for bone metastasis was higher than that of whole body bone scan (P<0.05). When Gleason score>8, PET/CT was more effective in detecting bone metastasis. The detection rate was higher than that of whole body bone scan (P<0.05). The lesions with positive PET/CT but not diagnosed by bone scan were mainly located in the chest bone, spine bone, and pelvic bone; the lesions with positive bone scan but missed by PET/CT were also more common in chest bone, with low nuclide uptake. The average SUVmax was 2.62±0.47 (1.60-3.30), and adjacent to the liver, spleen or salivary glands with higher metabolism. There were 21/51 (41.18%) cases of lymph node metastasis found outside of bone, 5/51 (9.80%) cases of lung metastasis, and 1/51 (1.96%) cases of liver metastasis. 【Conclusion】 18F-PSMA PET/CT imaging is significantly superior to 99mTc-MDP whole-body bone imaging in diagnosing bone metastasis of prostate cancer, and it can detect metastases other than bone.

The relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopahtological characteristics in patients treated with radical prostatectomy / 中华泌尿外科杂志

Objective To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy.Methods The clinicopahtological data of patients evaluated with 68Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed.31 patients with a mean age (63.1 ± 4.9) and baseline PSA (72.71 ± 173.15) ng/ml were enrolled.Their BMI mean (24.6 ± 3.0) kg/m2.Baseline testosterone of 14 patients was (4.72 ± 1.64) ng/ml.Based on the Gleason scores related ISUP classification,all patients were classified into grade one in 5 cases,grade 2in 7 cases,grade 3 in 4 cases,grade 4 in 10 cases and grade 5 in 5 cases.The clinical classification included 6 cases in T2a stage,2 cases in T2b stage,17 cases in T2c stage,1 case in T3a stage,4 cases in T3b stage and 1 case in T4 stage.SUVmax was accessed by two independent professional nuclear medicine physicians.SUVmax was 12.49 ± 9.38.SPSS 16.0 software was used to do statistic analysis.Results The post-operative pathological results showed the surgical margin positive in 19 cases,negative in 12 cases,vascular positive in 5 cases,negative in 20 case,positive nerve invasion in 20 cases and negative in 11 cases.2 patients were low risk,7 patients were medium risk and 22 patients were high risk according to D'Amico classification.Based on the basis of PSA(≤ 10 or ＞ 10) and Gleason score (≤6 or ＞ 6),6 patients were in group with low PSA and low Gleason score,5 patients were low PSA and high Gleason score,9 patients were high PSA and low Gleason score,11 patients were high PSA and high Gleason score.SUVmax had a significant positive relationship with pathological ISUP (r =0.434,P =0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli (14.78 ± 10.68 vs.8.17 ± 2.81,P =0.005).No significant correlation was found between SUVmax and baseline PSA,testosterone,pathologic T stage,surgical margin,nerve invasion,pelvic lymph node status as well as risk stratification.SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P =0.033) and the sensitivity was 88.9％.The specificity was 77.3％ when SUVmax ≥ 11.34.SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01 ± 5.40 vs.4.98 ± 2.11,P =0.007).Conclusions SUVmax measured on preoperative 68 Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy.

The relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopahtological characteristics in patients treated with radical prostatectomy / 中华泌尿外科杂志

Objective@#To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy.@*Methods@#The clinicopahtological data of patients evaluated with 68Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed. 31 patients with a mean age (63.1±4.9) and baseline PSA (72.71±173.15)ng/ml were enrolled. Their BMI mean (24.6±3.0)kg/m2. Baseline testosterone of 14 patients was (4.72±1.64)ng/ml.Based on the Gleason scores related ISUP classification, all patients were classified into grade one in 5 cases, grade 2in 7 cases, grade 3 in 4 cases, grade 4 in 10 cases and grade 5 in 5 cases. The clinical classification included 6 cases in T2a stage, 2 cases in T2b stage, 17 cases in T2c stage, 1 case in T3a stage, 4 cases in T3b stage and 1 case in T4 stage. SUVmax was accessed by two independent professional nuclear medicine physicians. SUVmax was 12.49±9.38. SPSS 16.0 software was used to do statistic analysis.@*Results@#The post-operative pathological results showed the surgical margin positive in 19 cases, negative in 12 cases, vascular positive in 5 cases, negative in 20 case, positive nerve invasion in 20 cases and negative in 11 cases. 2 patients were low risk, 7 patients were medium risk and 22 patients were high risk according to D′Amico classification. Based on the basis of PSA(≤10 or>10) and Gleason score(≤6 or>6), 6 patients were in group with low PSA and low Gleason score, 5 patients were low PSA and high Gleason score, 9 patients were high PSA and low Gleason score, 11 patients were high PSA and high Gleason score. SUVmax had a significant positive relationship with pathological ISUP(r=0.434, P=0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli(14.78±10.68 vs. 8.17±2.81, P=0.005). No significant correlation was found between SUVmax and baseline PSA, testosterone, pathologic T stage, surgical margin, nerve invasion, pelvic lymph node status as well as risk stratification. SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P=0.033) and the sensitivity was 88.9%. The specificity was 77.3% when SUVmax≥11.34. SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01±5.40 vs. 4.98±2.11, P=0.007).@*Conclusions@#SUVmax measured on preoperative 68Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy.

⁶⁸Ga-PSMA PET/CT Imaging Predicting Intraprostatic Tumor Extent, Extracapsular Extension and Seminal Vesicle Invasion Prior to Radical Prostatectomy in Patients with Prostate Cancer / 대한핵의학회잡지

PURPOSE: ⁶⁸Ga-labeled prostate-specific membrane antigen (PSMA) ligand positron emission tomography/computed tomography (PET/CT) has shown promising results in patients with biochemical recurrence after primary therapy for prostate cancer. In this study, we evaluated the usefulness of PSMA I&T (imaging and therapy) PET/CT prior to radical prostatectomy.METHODS: The study population consisted of 21 patients with prostate cancer who underwent ⁶⁸Ga-PSMA I&T PET/CT before either open or laparoscopic radical prostatectomy. Intraprostatic tumor extent, extracapsular extension (ECE) and seminal vesicle invasion (SVI) were assessed on the PET/CT scans. Tracer uptake was quantified in terms of standardized uptake values (SUVs). Imaging findings were correlated with final whole-gland histopathology.RESULTS: Of the 21 patients, two had T stage 2b disease, nine stage 2c, six stage 3a and four stage 3b. The median Gleason score was 7. The SUV(mean) of the primary tumors was 9.5 ± 8.8. SUV(mean) was higher in tumors with ECE than in organconfined tumors (13.8 ± 11.0 vs. 5.6 ± 3.2, p = 0.029). Peak tracer uptake was significantly positively correlated with Gleason score (r(s) = 0.49, p = 0.025). Sensitivity, specificity, positive predictive value and negative predictive value were, respectively, 94.7%, 75.0%, 97.3% and 60.0% for tumor infiltration of an individual prostate lobe, 75.0%, 100.0%, 100.0% and 97.4% for SVI, and 90.0%, 90.9%, 90.0% and 90.9% for ECE, using an angulated contour of the prostate as the criterion. Tumor volume derived from ⁶⁸Ga-PSMA I&T PET/CT was significantly correlated with preoperative prostate-specific antigen value (r(p) = 0.75, p < 0.001) and tumor volume on histopathology (r(p) = 0.45, p = 0.039).CONCLUSIONS: ⁶⁸Ga-PSMA I&T PET/CT prior to radical prostatectomy can contribute to presurgical local staging of prostate cancer. In this pilot study, ⁶⁸Ga-PSMA I&T PET/CT showed promising results for prediction of lobe infiltration, ECE and SVI.

Effect of Prostate Specific Membrane Antigen on Angiogenesis / 대한비뇨기과학회지

PURPOSE: PSMA (prostate specific membrane antigen) is a transmembrane glycoprotein, which is isolated from LNCaP. It is reported that PSMA is expressed in the vascular endothelium of various tumor. It has been suggested that PSMA can be related to angiogenesis. Herein, the effect of PSMA on angiogenesis was investigated with the HUVEC (human umbilical vein endothelial cell) line transfected with PSMA. MATERIALS AND METHODS: mRNA was extracted from LNCaP. RT-PCR for PSMA ORF (open reading frame) was performed. PSMA ORF cDNA was subcloned into PcDNA 3.1(-) (BamH1 and Xba1 site) and transfection of PSMA on HUVEC was performed. HUVEC was plated onto a Matrigel coated 6 well plate and incubated at 37oC in a CO2 incubator for 18 hours. The HUVEC tube formation was observed every 2 hours using an inverted microscope. HUVEC cell protein was extracted immediately, and 3 and 6 hours after transfection. Western blot for VEGF (vascular endothelial growth factor) was performed. RESULTS: The tube formation stage of HUVEC transfected with PSMA was observed 10 hours after incubation on Matrigel coating, whereas in the control HUVEC, the cord formation stage was observed after up to 10 hours incubation. The HUVEC transfected with PSMA showed an earlier tube formation stage than the control. Western blot analysis showed that PSMA transfection on HUVEC increased the expression of VEGF 2.5 fold in 3 hours and 1.89 fold in 6, as measured by densitometry. CONCLUSIONS: PSMA transfection on the HUVEC cell line induced an initial increase in the expression of VEGF, and subsequently stimulated an earlier tube formation in the HUVEC cell line. These data suggest PSMA is related to angiogenesis.

Effect of Prostate Specific Membrane Antigen on Angiogenesis / 대한비뇨기과학회지

PURPOSE: PSMA (prostate specific membrane antigen) is a transmembrane glycoprotein, which is isolated from LNCaP. It is reported that PSMA is expressed in the vascular endothelium of various tumor. It has been suggested that PSMA can be related to angiogenesis. Herein, the effect of PSMA on angiogenesis was investigated with the HUVEC (human umbilical vein endothelial cell) line transfected with PSMA. MATERIALS AND METHODS: mRNA was extracted from LNCaP. RT-PCR for PSMA ORF (open reading frame) was performed. PSMA ORF cDNA was subcloned into PcDNA 3.1(-) (BamH1 and Xba1 site) and transfection of PSMA on HUVEC was performed. HUVEC was plated onto a Matrigel coated 6 well plate and incubated at 37oC in a CO2 incubator for 18 hours. The HUVEC tube formation was observed every 2 hours using an inverted microscope. HUVEC cell protein was extracted immediately, and 3 and 6 hours after transfection. Western blot for VEGF (vascular endothelial growth factor) was performed. RESULTS: The tube formation stage of HUVEC transfected with PSMA was observed 10 hours after incubation on Matrigel coating, whereas in the control HUVEC, the cord formation stage was observed after up to 10 hours incubation. The HUVEC transfected with PSMA showed an earlier tube formation stage than the control. Western blot analysis showed that PSMA transfection on HUVEC increased the expression of VEGF 2.5 fold in 3 hours and 1.89 fold in 6, as measured by densitometry. CONCLUSIONS: PSMA transfection on the HUVEC cell line induced an initial increase in the expression of VEGF, and subsequently stimulated an earlier tube formation in the HUVEC cell line. These data suggest PSMA is related to angiogenesis.