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Objective <p>This prospective study aims to compare the diagnostic yield of conventional imaging modalities, including CT scan, bone scan, with <sup>99 m</sup>Tc-HYNIC-PSMA-11, in detecting local and distant metastases for initial staging in treatment-naïve, intermediate- to high-risk prostate cancer (PCa) patients. <sup>68</sup>&#xa0;Ga-PSMA or 18F-PSMA PET/CT scans are known as the preferred modalities for staging this kind of patients, but there are limited PET/CT facilities in developing countries. </p> Materials and methods <p>A total of 63 treatment-naïve PCa patients were included in the study for the initial staging. Each patient underwent a chest and abdominopelvic CT scan, bone scan, and <sup>99 m</sup>Tc-HYNIC-PSMA-11 imaging. <sup>99 m</sup>Tc-HYNIC-PSMA-11 (20–25&#xa0;mCi) and <sup>99 m</sup>TC-MDP (20–25&#xa0;mCi) were administered intravenously, and imaging was performed 3–4&#xa0;h post-injection. Nuclear scans included whole-body imaging with SPECT or SPECT/CT phases in two fields (thorax and abdominopelvic), along with imaging of suspicious areas. All images were independently interpreted and analyzed on a patient-based and region-based level.</p> Results <p>Region-based analysis revealed osseous metastatic regions in 78 (median 0 per patient, range 0–9), 25, and 87 (median 2 per patient, range 0–9) regions in the PSMA-11 scan, CT scan, and bone scan, respectively. CT scan was limited in assessing all nine osseous regions due to its restricted field of view. </p> <p>The positive detection rate for local lymph-node and distant metastases (distant lymphatic, osseous, and visceral) was 18/63 (28.6%) and 23/63 (41.3%) for the PSMA-11 scan, and 20/63 (31.8%) and 27/63 (42.9%) for the CT scan, with no significant difference between the two modalities. Overall, the combined findings of the PSMA-11 scan, CT scan, and bone scan were positive in 31/63 (49.2%), 34/63 (53.9%), and 32/63 (50.8%) patients, respectively. Equivocal findings were reported in 1 PSMA-11 scan, 13 CT scans, and 4 bone scans. When equivocal findings were considered as positive for metastasis, the accuracy, sensitivity, and specificity were 78.2%, 60%, and 96.4% for the PSMA-11 scan; 76.1%, 62.9%, and 89.3% for the CT scan; and 85%, 78.6%, and 91.4% for the bone scan. There was a strong agreement in disease staging and overall findings between the PSMA-11 scan and the combination of CT and bone scans (Ƙ = 0.949 and Ƙ = 0.905, respectively; <i>p</i> &lt; 0.001).</p> Conclusion <p>The comparable accuracy and high concordance between <sup>99 m</sup>Tc-HYNIC-PSMA-11 and conventional CT and bone scans make <sup>99 m</sup>Tc-HYNIC-PSMA-11 an effective method for initial staging of intermediate- to high-risk prostate cancer patients.</p>

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The diagnostic value of whole-body HYNIC-PSMA 11 -Tc [99 mTc] SPECT/CT scan in early staging of patients with moderate- and high-risk prostate cancer

  • 期刊论文

  • 发表日期：

    2025年5月10日

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  • Vahid RoshanRavan,
  • Hamidreza Ghorbani,
  • Salman Soltani,
  • Elham Shabani,
  • Hosein Tanha,
  • Ali Moradi,
  • Kamran Aryana,
  • Hasan Mehrad Majd,
  • Behzad Aminzadeh,
  • Reza Jafaei Daloei,
  • Keyvan Sadri,
  • Mahdi Momen Nejhad,
  • Atena Aghaee

摘要

Objective

This prospective study aims to compare the diagnostic yield of conventional imaging modalities, including CT scan, bone scan, with 99 mTc-HYNIC-PSMA-11, in detecting local and distant metastases for initial staging in treatment-naïve, intermediate- to high-risk prostate cancer (PCa) patients. 68 Ga-PSMA or 18F-PSMA PET/CT scans are known as the preferred modalities for staging this kind of patients, but there are limited PET/CT facilities in developing countries.

Materials and methods

A total of 63 treatment-naïve PCa patients were included in the study for the initial staging. Each patient underwent a chest and abdominopelvic CT scan, bone scan, and 99 mTc-HYNIC-PSMA-11 imaging. 99 mTc-HYNIC-PSMA-11 (20–25 mCi) and 99 mTC-MDP (20–25 mCi) were administered intravenously, and imaging was performed 3–4 h post-injection. Nuclear scans included whole-body imaging with SPECT or SPECT/CT phases in two fields (thorax and abdominopelvic), along with imaging of suspicious areas. All images were independently interpreted and analyzed on a patient-based and region-based level.

Results

Region-based analysis revealed osseous metastatic regions in 78 (median 0 per patient, range 0–9), 25, and 87 (median 2 per patient, range 0–9) regions in the PSMA-11 scan, CT scan, and bone scan, respectively. CT scan was limited in assessing all nine osseous regions due to its restricted field of view.

The positive detection rate for local lymph-node and distant metastases (distant lymphatic, osseous, and visceral) was 18/63 (28.6%) and 23/63 (41.3%) for the PSMA-11 scan, and 20/63 (31.8%) and 27/63 (42.9%) for the CT scan, with no significant difference between the two modalities. Overall, the combined findings of the PSMA-11 scan, CT scan, and bone scan were positive in 31/63 (49.2%), 34/63 (53.9%), and 32/63 (50.8%) patients, respectively. Equivocal findings were reported in 1 PSMA-11 scan, 13 CT scans, and 4 bone scans. When equivocal findings were considered as positive for metastasis, the accuracy, sensitivity, and specificity were 78.2%, 60%, and 96.4% for the PSMA-11 scan; 76.1%, 62.9%, and 89.3% for the CT scan; and 85%, 78.6%, and 91.4% for the bone scan. There was a strong agreement in disease staging and overall findings between the PSMA-11 scan and the combination of CT and bone scans (Ƙ = 0.949 and Ƙ = 0.905, respectively; p < 0.001).

Conclusion

The comparable accuracy and high concordance between 99 mTc-HYNIC-PSMA-11 and conventional CT and bone scans make 99 mTc-HYNIC-PSMA-11 an effective method for initial staging of intermediate- to high-risk prostate cancer patients.