PSMA PET/CT在淋巴结和骨转移评估中的应用

2.2.4 Lymph Node and Bone Metastasis Evaluation The sensitivity and specificity of PSMAPET/CT for detecting lymph node metastases are significantly superior to those of CT and MRI. A meta-analysis showed that the sensitivity of PSMAPET/CT for lymph node metastases was 73.7%, and the specificity was 97.5%. Studies have demonstrated that PET/CT has significant diagnostic efficacy in lymph node staging, which can help avoid unnecessary pelvic lymphadenectomy. The sensitivity of PSMAPET/CT for bone metastases is 98.0%, and the specificity is 96.2%, significantly better than traditional bone scans. A retrospective study confirmed that PSMA-PET/CT has moderate to high histopathological consistency and positive predictive value in diagnosing bone metastases in prostate cancer, and the peak SUV is helpful in distinguishing between biopsy-positive and biopsy-negative lesions. Additionally, 18F-PSMA-1007 detects more prostate cancer bone metastases in different bone regions compared to 18F-FDG, and 18F-PSMA-1007 PET/CT has high sensitivity and accuracy, potentially becoming a new standard for diagnosing bone metastases in prostate cancer. 2.2.5 Application in Advanced PCa PSMAPET/CT has been recommended as an imaging examination for patients with advanced prostate cancer. Numerous studies have shown that PSMAPET/CT has certain diagnostic performance in advanced prostate cancer. With technological advancements and the introduction of multiple imaging reporting standards, PSMAPET/CT can provide valuable assistance in formulating treatment strategies for patients with advanced PCa. 2.2.6 Biochemical Recurrence Localization After radical treatment for prostate cancer, 27% to 53% of patients experience biochemical recurrence, which is a harbinger of local recurrence and distant metastasis. However, PSMA PET/CT has a significant advantage in localizing biochemical recurrence (BCR) after radical prostatectomy. Even when PSA levels are as low as 0.2 ng/ml, the detection rate of PSMA PET/CT can still reach 38-50%, far higher than that of traditional imaging. Expert consensus strongly recommends PSMA PET/CT as the preferred localization method for BCR patients. For patients suspected of having local recurrence, PSMA PET/MRI is recommended to improve local soft tissue resolution. For patients who do not meet the criteria for biochemical recurrence but have persistently rising PSA levels, PSMA PET/CT can also aid in diagnosis.