Clinical Application of Prostate-specific Membrane Antigen PET/CT for Reducing Unnecessary Biopsies in Prostate Cancer
10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.2025.0215
- VernacularTitle:前列腺特异性膜抗原PET/CT对减少前列腺癌过度穿刺活检的应用价值
- Author:
Jishen ZHANG
1
;
Yujie XIE
2
;
Ting YANG
2
;
Ju JIAO
2
;
Zhaohui HE
1
Author Information
1. Department of Urology，The Eighth Affiliated Hospital of Sun Yat-sen University，Shenzhen 518033， China
2. Department of Nuclear Medicine，The Third Affiliated Hospital of Sun Yat-sen University， Guangzhou 510630， China
- Publication Type:Journal Article
- Keywords:
prostate biopsy;
prostate cancer;
PET/CT;
prostate-specific membrane antigen;
prostate-specific antigen density
- From:
Journal of Sun Yat-sen University(Medical Sciences)
2025;46(2):311-317
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveTo evaluate the application of prostate-specific membrane antigen （PSMA）PET/CT in prostate biopsy screening， and propose effective strategies for prostate biopsy decision making based on PSMA PET/CT detection. MethodsA retrospective analysis was conducted on PSMA PET/CT imaging and clinical pathological data from 155 patients with suspected prostate cancer between January 2020 and December 2023. PRIMARY score was used as the standardized evaluation method for PSMA PET/CT in the diagnosis of prostate cancer. And compared the positive prostate biopsy rates， missed diagnosis rates and biopsy reduction rates were compared regarding different PRIMARY scores. Receiver operating characteristic （ROC） curves were used to analyze prostate-specific antigen （PSA） and its derived parameters and identify the most suitable supplementary screening indicators for combined use with the PRIMARY score. ResultsAmong patients with PRIMARY scores of 1 to 5， the proportions of patients diagnosed with prostate cancer were 15.8% （3/19）， 17.1% （7/41）， 50% （12/24）， 95.2% （20/21） and 98% （49/50）， respectively. Using PRIMARY score of 3-5 as the biopsy screening strategy resulted in a positive prostate biopsy rate of 85.3% and biopsy reduction rate of 38.7%， but a missed diagnosis rate of 11%. PSA density > 0.15 ng/（mL·cm³） was selected as a supplementary screening criterion to detect prostate cancer from patients with PRIMARY scores of 1-2. The combined application of the above two screening criteria reduced the missed diagnosis rate to 2.2%. ConclusionThis study proposes a novel biopsy screening strategy for suspected prostate cancer patients using PSMA PET/CT， that is， a PRIMARY score of 3-5 or a PRIMARY score of 1-2 but PSA density>0.15 ng/（mL·cm³）， which can effectively avoid unnecessary biopsies and significantly reduce the missed diagnosis rate.
