Combining 18F-PSMA PET/CT and biparametric MRI predicts pathological upgrading after radical prostatectomy for prostate cancer
Objective To investigate the application value of the maximum standardized uptake value(SUVmax)of 18F prostate-specific membrane antigen(PSMA)PET/CT combined with the minimum apparent diffusion coefficient(ADCmin)of biparametric magnetic resonance imaging(bpMRI)in predicting pathological upgrading after radical prostatectomy(RP)for prostate cancer.Methods The data of 89 patients with localized prostate cancer treated at Beijing Hospital from April 2019 to October 2023 were retrospectively analysed.The average age of patients was(68.4±7.0)years old,with prostate-specific antigen(PSA)levelof7.7(5.4,12.9)ng/ml,prostate volume of 34.6(26.9,47.1)ml,tumor diameter of 1.3(1.0,1.8)cm,prostate imaging reporting and data system(PI-RADS)score of 5 in 29 cases(32.6％),clinical stage ≥T3 in 13 cases(14.6％).There were 31 cases(34.8％)in group 1 of targeted biopsy International Society of Urological Pathology(ISUP)grading groups,36 cases(40.4％)in group 2,11 cases(12.4％)in group 3,and 11 cases(12.4％)in group 4.All patients underwent 18F-PSMA PET/CT and bpMRI examinations before RP.The index lesion,identified as the highest Gleason score in pathological whole-mount sections,were outlined.SUVmax and ADCmin values were calculated from the images'region of interest.Pathological upgrading was defined as the post-RP grade group higher than the targeted-biopsy grade group.Clinical data of patients with and without pathological upgrading were compared.Spearman correlation coefficient analysis was used to assess the correlation between SUVmax and ADCmin.Multivariate logistic regression analysis was conducted to evaluate the factors influencing pathological upgrading.Receiver operating characteristic(ROC)curve analysis was employed to assess the predictive value of each indicator for pathological upgrading.Results Among the 89 cases,31 cases(34.8％)experienced pathological upgrading.Compared with the patients without pathological upgrading,the SUVmax[11.3(8.1,16.4)vs.6.7(4.6,9.2)],SUVmax/ADCmin ratio[3.1(2.0,4.6)vs.1.4(0.9,2.1)],PSA[9.8(6.3,15.6)ng/ml vs.7.1(5.1,10.5)ng/ml],PSA density[0.3(0.2,0.5)ng/ml2 vs.0.2(0.1,0.3)ng/ml2],and post-RP ISUP grade group[≥3 group 17 cases(54.8％)vs.13 cases(22.4％)]were higher in patients with pathological upgrading,while ADCmin[3.8(3.0,5.3)× 10-4 mm2/s vs.5.2(3.6,6.1)× 10-4 mm2/s]and targeted biopsy ISUP grade group[≤2 group 27 cases(87.1％)vs.40 cases(69.0％)]were lower(all P＜0.05).Spearman analysis showed a negative correlation between SUVmax and ADCmin(R=-0.227,P=0.032).Multivariate logistic regression analysis revealed that SUVmax(OR=1.108,95％CI 1.020-1.238),ADCmin(OR=0.607,95％CI 0.390-0.874),and SUVmax/ADCmin ratio(OR=1.815,95％CI 1.282-2.949)independently predicted pathological upgrading.The AUC of the SUVmax/ADCmin ratio for predicting pathological upgrading(AUC=0.817)was higher than that of SUVmax(AUC=0.774)and ADCmin(AUC=0.686),indicating a higher predictive efficiency.Conclusions SUVmax,ADCmin,and SUVmax/ADCmin ratio can independently predict pathological upgrading in targeted biopsy of prostate cancer.The SUVmax/ADCmin ratio has a stronger predictive value for pathological upgrading.
NETL
NSTL
万方数据
