Burak, Emine ACAR, PEMBE KESKİNOĞLU, ERKAN DEREBEK

Prostat kanserli hastalarda laboratuvar/patoloji bulguları ile Ga-68 PSMA PET/BT bulgularının ilişkisi

Amaç: Prostat kanseri nedeniyle Ga-68 PSMA PET/BT görüntülemesi yapılan hastaların görüntülemelerinde saptanan bulguları; patoloji, laboratuvar bulguları ile karşılaştırmaktır. Gereç ve Yöntem: “Evreleme" ve “yeniden evreleme” amaçlı PSMA PET/BT görüntülemesi yapılan 123 hasta retrospektif olarak incelendi. Tüm hastaların prostat, lenf nodu, kemik, visseral organ ve en yüksek SUVmax değerleri ölçüldü. Bu değerler ile “Gleason Skoru”, “Gleason Grade” ve laboratuvar bulguları arasındaki korelasyon değerlendirildi. PSMA PET/BT’de patolojik bulgu saptanmayan hastalar ile saptananlar arasında patoloji ve laboratuvar bulguları arasındaki farklılıklar incelendi. Bulgular: Tüm grupta PSMA PET/BT’de kemik tutulumu saptanmayan hastalar ile saptananlar arasında ALP ve Ca değerleri anlamlı farklılık göstermektedir(sırasıyla p: 0,010,p: 0,003). En yüksek SUVmax değerleri ile LDH değerleri arasında çok zayıf korelasyon saptanmıştır (r=0,19). Perinöral invazyonu olmayan hastalar ile olan hastaların en yüksek SUVmax değerleri anlamlı farklılık göstermektedir (p=0,012). Evreleme grubunda prostat SUVmax ve en yüksek SUVmax değerleri ile GG ve PSA değerleri arasında orta düzeyde korelasyon saptanmıştır (sırasıyla r=0,42, r=0,5, r=0,54, r=0,53). “Gleason Grade” 2 ve altında olan hastalar ile 2’nin üzerinde olan hastaların, prostat SUVmax ve en yüksek SUVmax değerleri anlamlı farklılık göstermektedir (sırasıyla p=0,005, p=0,002). PSA değeri 20 ng/ml ve altında olan hastalar ile 20 ng/ml’nin üzerinde olan hastaların prostat SUVmax değerleri anlamlı farklılık göstermektedir (p= 0,045). Yeniden evreleme grubunda visseral organ ve en yüksek SUVmax değerleri ile PSA değerleri arasında orta düzeyde korelasyon saptanmıştır (sırasıyla r=0,56, r=0,43). Ga-68 PSMA PET/BT’de patolojik bulgu saptanmayan hastalar ile patolojik bulgu saptanan hastalar arasında; PSA değerleri, GS, GG anlamlı farklılık göstermektedir (sırasıyla p<0,001, p=0,032, p=0,030). Sonuç: Çalışma bulgularımız orta-yüksek risk grubundaki hastalarda evreleme amaçlı, nüks şüphesi veya biyokimyasal nüks durumu olan hastalarda yeniden evreleme amaçlı PSMA PET/BT görüntülemesinin rutin kullanıma girmesi gerektiğini düşündürmektedir. PSMA PET/BT’de saptanan bulguların ve SUVmax değerlerinin, gerek histopatolojik, gerek laboratuvar bulguları ile ilişkili olması, SUVmax değerlerinin de prognostik faktör olarak kullanılabileceğini düşündürmektedir.

Anahtar Kelimeler:

Ga-68 PSMA PET/BT, SUVmax, Gleason Skoru, Gleason Grade

THE RELATIONSHIP BETWEEN LABORATORY/PATHOLOGY RESULTS AND GA-68 PSMA PET/CT FINDINGS IN PATIENTS WITH PROSTATE CANCER

Objective: To compare imaging results and pathology, laboratory results and to analyze the relationship between them in patients who were performed PSMA PET/CT due to prostate cancer. Materials and Methods: 123 patients who were performed PSMAPET/CT for “staging” and “re-staging” were analyzed retrospectively. SUVmax values were measured for prostate, lymph node, bone and visceral organs. The correlation between these values and Gleason score/grade and laboratory results were evaluated. The differences between the patients who were detected and not detected to have pathological findings on PET/CT were evaluated with regard to pathology and laboratory results. Results: A significant difference was detected between the patients who were detected and not detected to have bone involvement on PET/CT with regard to ALP and Ca values (p=0.010, p=0.003, respectively). A very weak correlation was detected between the highest SUVmax and LDH (r=0.19). There was a significant difference between the patients with and without peri-neural invasion with regard to maximum SUVmax (p=0.012). In staging group, a moderate correlation was detected between prostate SUVmax, the highest SUVmax and GG and PSA (r=0.42, r=0.5, r=0.54, r=0.53, respectively). A significant difference was detected between the patients whose GG was ≤2 and GG>2 with regard to prostate SUVmax and the highest SUVmax (p=0.005, p=0.002; respectively). There was a significant difference between the patients whose PSA was ≤20 and >20 ng/ml with regard to prostate SUVmax (p=0.045). PSA, GS, GG showed significant differences between the patients who were negative and positive on PET/CT (p<0.001, p= 0.032, p=0.030; respectively). Conclusion: Results of the study suggest that PSMAPET/CT should routinely be used for staging in intermediate-high risk patients and for re-staging in patients who are suspected to have recurrence or who have biochemical recurrence

___

GLOBOCAN 2018 [Internet]. [Erişim tarihi: 14/04/2020]. Erişim adresi: https://gco.iarc.fr/today/data/factsheets/cancers/27-Prostate-fact-sheet.pdf
Weineisen M, Schottelius M, Simecek J, Baum RP, Yildiz A, Beykan S, et al. 68Ga- and 177Lu-Labeled PSMA I&T: Optimization of a PSMA-Targeted Theranostic Concept and First Proof-of-Concept Human Studies. J Nucl Med. 2015;56(8):1169–76.
Martin R, Jüttler S, Müller M, Wester H-J. Cationic eluate pretreatment for automated synthesis of [68Ga]CPCR4.2. Nucl Med Biol. 2014;41(1):84–9.
Marchal C, Redondo M, Padilla M, Caballero J, Rodrigo I, García J, et al. Expression of prostate specific membrane antigen (PSMA) in prostatic adenocarcinoma and prostatic intraepithelial neoplasia. Histol Histopathol. 2004;19(3):715–8.
Uprimny C, Kroiss AS, Decristoforo C, Fritz J, von Guggenberg E, Kendler D, et al. 68Ga-PSMA-11 PET/CT in primary staging of prostate cancer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumour. Eur J Nucl Med Mol Imaging. 2017;44(6):941–9.
Mannweiler S, Amersdorfer P, Trajanoski S, Terrett JA, King D, Mehes G. Heterogeneity of prostate-specific membrane antigen (PSMA) expression in prostate carcinoma with distant metastasis. Pathol Oncol Res. 2009;15(2):167–72.
Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA, et al. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol. 2016;40(2):244–52.
Chun FK-H, Steuber T, Erbersdobler A, Currlin E, Walz J, Schlomm T, et al. Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology. Eur Urol. 2006;49(5):820–6.
Karan D, Kelly DL, Rizzino A, Lin M-F, Batra SK. Expression profile of differentially-regulated genes during progression of androgen-independent growth in human prostate cancer cells. Carcinogenesis. 2002;23(6):967–75.
Bailey J, Piert M. Performance of 68Ga-PSMA PET/CT for Prostate Cancer Management at Initial Staging and Time of Biochemical Recurrence. Curr Urol Rep. 2017;18(11):84.
Lenzo NP, Meyrick D, Turner JH. Review of Gallium-68 PSMA PET/CT Imaging in the Management of Prostate Cancer. Diagnostics (Basel, Switzerland). 2018;8(1):16.
Öbek C, Doğanca T, Demirci E, Ocak M, Kural AR, Yıldırım A, et al. The accuracy of 68Ga-PSMA PET/CT in primary lymph node staging in high-risk prostate cancer. Eur J Nucl Med Mol Imaging. 2017;44(11):1806–12.
Villers A, McNeal JE, Redwine EA, Freiha FS, Stamey TA. The Role of Perineural Space Invasion in the Local Spread of Prostatic Adenocarcinoma. J Urol. 1989;142(3):763–8.
Harnden P, Shelley MD, Clements H, Coles B, Tyndale-Biscoe RS, Naylor B, et al. The prognostic significance of perineural invasion in prostatic cancer biopsies: a systematic review. Cancer. 2007;109(1):13–24.
Beard C, Schultz D, Loffredo M, Cote K, Renshaw AA, Hurwitz MD, et al. Perineural invasion associated with increased cancer-specific mortality after external beam radiation therapy for men with low- and intermediate-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2006;66(2):403–7.
Quinn DI, Henshall SM, Brenner PC, Kooner R, Golovsky D, O’Neill GF, et al. Prognostic significance of preoperative factors in localized prostate carcinoma treated with radical prostatectomy: importance of percentage of biopsies that contain tumor and the presence of biopsy perineural invasion. Cancer. 2003;97(8):1884–93.
von Klot C-AJ, Merseburger AS, Böker A, Schmuck S, Ross TL, Bengel FM, et al. 68Ga-PSMA PET/CT Imaging Predicting Intraprostatic Tumor Extent, Extracapsular Extension and Seminal Vesicle Invasion Prior to Radical Prostatectomy in Patients with Prostate Cancer. Nucl Med Mol Imaging. 2017;51(4):314–22.
Ceci F, Uprimny C, Nilica B, Geraldo L, Kendler D, Kroiss A, et al. (68)Ga-PSMA PET/CT for restaging recurrent prostate cancer: which factors are associated with PET/CT detection rate? Eur J Nucl Med Mol Imaging. 2015;42(8):1284–94.
Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B, et al. Evaluation of Hybrid 68Ga-PSMA Ligand PET/CT in 248 Patients with Biochemical Recurrence After Radical Prostatectomy. J Nucl Med. 2015;56(5):668–74.
Thomas L, Balmus C, Ahmadzadehfar H, Essler M, Strunk H, Bundschuh RA. Assessment of Bone Metastases in Patients with Prostate Cancer-A Comparison between 99mTc-Bone-Scintigraphy and [68Ga]Ga-PSMA PET/CT. Pharmaceuticals (Basel). 2017;10(3):68.
Chaussé G, Niazi T, Abikhzer GS, Probst SM. Biopsy-Proven Diffuse Mediastinal Prostate Cancer Metastases Negative on 18F-Fluorocholine, Diagnosed on 68Ga-PSMA and 18F-PSMA PET/CT. Clin Nucl Med. 2017;42(10):801–2.