Background and purpose

Enhanced lesion detection in prostate cancer is observed with late [⁶⁸ Ga]Ga-PSMA-11 PET/CT imaging compared to standard [⁶⁸ Ga]Ga-PSMA-11 PET/CT imaging (50–100 min p.i.). However, the poor image quality of late imaging using short axial field of view (SAFOV) PET/CT has hindered its sole clinical adoption. Conversely, the image quality of late imaging with a long axial field of view (LAFOV) [⁶⁸ Ga]Ga-PSMA-11 PET/CT fulfills clinical diagnostic requirements. Nonetheless, the diagnostic efficacy of late LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT with forced diuresis and its impact on treatment decisions, compared to standard LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT, remains unclear. This study aims to compare the rate of PET positivity between late and standard LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT and to evaluate the influence of late LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT with forced diuresis on treatment decisions relative to standard scans.

Methods

From January 2021 to April 2024, 127 patients with biochemical recurrence of prostate cancer post-radical prostatectomy were enrolled to undergo both standard and late LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT scans at Shanghai Renji Hospital. We compared the rate of PET positivity between the two modalities at the patient level and across different anatomical regions. We assessed the added diagnostic value of late LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT and its impact on modifying patient treatment plans.

Results

The image quality of late LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT with forced diuresis in all patients met clinical diagnostic requirements. The rate of PET positivity of late LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT with forced diuresis were significantly higher than those of standard LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT (80.31% [102/127] vs. 65.35% [83/127]; P < 0.001). Late LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT demonstrated higher lesion SUVmax (16.69 ± 16.42 vs. 11.91 ± 10.72, P < 0.001) and TBR (6.26 ± 7.21 vs. 3.44 ± 3.57, P < 0.001) compared to standard LAFOV scans. Additionally, 14.17% (18/127) of patients experienced changes in their treatment regimen due to the superior detection capabilities of late LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT with forced diuresis compared to the standard scan.

Conclusions

The rate of PET positivity of late LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT with forced diuresis compared to standard LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT highlight its potential as a valuable diagnostic tool for biochemically recurrent prostate cancer. This study paves the way for using late LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT with forced diuresis for prostate cancer imaging in daily clinical practice, facilitating more accurate and timely diagnoses.

中文翻译：

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晚期和标准全身 [68 Ga]Ga-PSMA-11 在生化复发性前列腺癌中的临床性能比较

 背景和目的

与标准 [⁶⁸ Ga]Ga-PSMA-11 PET/CT 成像（50-100 分钟 p.i.）相比，晚期 [⁶⁸ Ga]Ga-PSMA-11 PET/CT 成像观察到前列腺癌病变检测增强。然而，使用短轴向视野 （SAFOV） PET/CT 的晚期成像图像质量差，阻碍了其唯一的临床采用。相反，具有长轴向视场 （LAFOV） [⁶⁸ Ga]Ga-PSMA-11 PET/CT 的晚期成像图像质量满足临床诊断要求。尽管如此，与标准 LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT 相比，晚期 LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT 联合强制利尿的诊断疗效及其对治疗决策的影响仍不清楚。本研究旨在比较晚期和标准 LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT 之间的 PET 阳性率，并评估晚期 LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT 联合强制利尿对治疗决策的影响相对于标准扫描。

 方法

2021 年 1 月至 2024年4月，入组 127 例前列腺根治术后前列腺癌生化复发患者，在上海仁济医院接受标准和晚期 LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT 扫描。我们比较了两种方式在患者水平和不同解剖区域的 PET 阳性率。我们评估了晚期 LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT 的额外诊断价值及其对修改患者治疗计划的影响。

 结果

所有患者晚期 LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT 强制利尿的图像质量均符合临床诊断要求。晚期 LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT 伴强制利尿的 PET 阳性率显著高于标准 LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT （80.31% [102/127] vs. 65.35% [83/127];P < 0.001）。晚期 LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT 显示更高的病变 SUVmax （16.69 ± 16.42 vs. 11.91 ± 10.72，P < 0.001） 和 TBR （6.26 ± 7.21 vs. 3.44 ± 3.57，P < 0.001） 与标准 LAFOV 扫描相比。此外，14.17% （18/127） 的患者由于与标准扫描相比，晚期 LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT 联合强制利尿的检测能力更强，因此治疗方案发生了变化。

 结论

与标准 LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT 相比，晚期 LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT 伴强制利尿的 PET 阳性率突出了其作为生化复发性前列腺癌的有价值诊断工具的潜力。本研究为在日常临床实践中使用晚期 LAFOV [⁶⁸ Ga]Ga-PSMA-11 PET/CT 联合强制利尿进行前列腺癌成像铺平了道路，有助于更准确、更及时的诊断。