PURPOSE There are limited data on PSMA PET/CT for workup of recurrence after radical prostatectomy (RP) at low PSA values. We evaluated a PSMA PET/CT cohort of patients with post-RP, focusing on patients with PSA < 0.5 ng/mL. MATERIALS AND METHODS We identified a retrospective cohort who underwent piflufolastat F-18 PSMA PET/CT across an 11 hospital system from July 2021 to February 2023. Prostate-specific membrane antigen (PSMA) positivity was determined by radiology reports. Univariable and multivariable logistic regression identified factors associated with suspicious PSMA activity. RESULTS Median PSA was 0.37 ng/mL (IQR, 0.15-1.29 ng/mL), with 49% of patients overall having at least 1 suspicious PSMA-avid lesion. Rates of scan positivity among patients with PSA < 0.2 and 0.2 to 0.5 ng/mL were 34% and 38%, respectively. Among all patients, 25% (104/415) had pelvic disease (prostate bed or N1) and 24% (100/415) had M1 disease. Among patients with PSA < 0.5 ng/mL, prior postoperative radiation was associated with suspicious PSMA activity. In the overall cohort, age, PSA at PSMA PET/CT, and RP Gleason grade were associated with PSMA positivity. PSADT, EAU risk, and CAPRA-S were all associated with suspicious PSMA activity. CONCLUSIONS Over one-third of patients with PSAs < 0.2 ng/mL had imaging findings concerning for recurrence. Prior postoperative radiation was associated with higher rates of PSMA positivity among patients with PSA < 0.5 ng/mL, and half of patients with evidence of PSMA avid distant metastatic disease underwent metastasis-directed therapy. PET-PSMA imaging at low PSAs can be considered to inform salvage therapies.

中文翻译：

---

最初接受根治性前列腺切除术的患者与可疑 18F-DCFPyL PSMA PET 活动相关的临床因素，包括前列腺特异性抗原 < 0.5 ng/mL。


目的 关于低 PSA 值根治性前列腺切除术 （RP） 后复发病情检查的 PSMA PET/CT 数据有限。我们评估了 RP 后患者的 PSMA PET/CT 队列，重点关注 PSA < 0.5 ng/mL 的患者。材料和方法 我们确定了一个回顾性队列，该队列于 2021 年 7 月至 2023 年 2 月在 11 家医院系统中接受了 piflufolastat F-18 PSMA PET/CT。前列腺特异性膜抗原 （PSMA） 阳性由放射学报告确定。单变量和多变量 logistic 回归确定了与可疑 PSMA 活动相关的因素。结果中位 PSA 为 0.37 ng/mL （IQR，0.15-1.29 ng/mL），49% 的患者总体上至少有 1 个可疑的 PSMA 亲和病灶。PSA < 0.2 和 0.2 至 0.5 ng/mL 患者的扫描阳性率分别为 34% 和 38%。在所有患者中，25% （104/415） 患有盆腔疾病 （前列腺床或 N1），24% （100/415） 患有 M1 疾病。在 PSA < 0.5 ng/mL 的患者中，既往术后放疗与可疑的 PSMA 活动相关。在整个队列中，年龄、 PSMA PET/CT 的 PSA 和 RP Gleason 分级与 PSMA 阳性相关。PSADT 、 EAU 风险和 CAPRA-S 都与可疑的 PSMA 活动有关。结论 超过 1/3 的 PSAs < 0.2 ng/mL 患者的影像学表现与复发有关。在 PSA < 0.5 ng/mL 患者中，既往术后放疗与 PSMA 阳性率较高相关，并且有 PSMA 狂热远处转移性疾病证据的患者中有一半接受了转移定向治疗。可以考虑在低 PSA 下进行 PET-PSMA 成像，为挽救治疗提供信息。