Radelumin（PSMA-1007）合併MRS（磁振頻譜）在攝護腺癌良惡性評估的應用。

-這是否會成為前列腺癌影像診斷的新工具?
吳志毅¹, 樊裕明^2,3(共同第一作者), 廖俊厚^3,4, 黃雅庭^1,5, 陳力瑜¹, 黃雅瑤^1,6
1. 普瑞默生物科技
2. 天主教耕莘醫療財團法人耕莘醫院核子醫學科           

3. 天主教輔仁大學醫學院醫學系

4. 天主教耕莘醫療財團法人耕莘醫院泌尿外科

5. 天主教靈醫會醫療財團法人羅東聖母醫院教學研究組
6. 國立台灣大學醫學院醫療器材與醫學影像研究所
 

Application of Radelumin (PSMA-1007) combined with MRS (Magnetic resonance spectroscopy) in the assessment of benign and malignant prostate cancer.
-Could this be a new tool for prostate cancer imaging diagnosis?

Chih-Yi Wu, BS¹, Yu-Min Fan, MD^2,3(co-first author), Chun-Hou Liao, MD, PhD^3,4, Ya-Ting Huang, RN, NP, PhD^1,5, Li-Yu Chen, MS¹, Ya-Yao Huang, PhD^1,6
1. Primo Biotechnology Co., Ltd, Taipei, Taiwan.
2. Department of Nuclear medicine of Cardinal Tien Hospital           

3.School of Medicine, College of Medicine, Fu Jen Catholic University

4. Department of Urology of Cardinal Tien Hospital

5. Department of Medical Education and Research, Camillian Saint Mary's Hospital.
6. Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan.
 

Abstract:

F-18 labeled PSMA-1007 (Radelumin) is commonly PET tracer used for the Metastatic castration resistant prostate cancer(mCRPCa) and biochemical recurrence prostate cancer(BCRPCa). Also known Radelumin has high specificity (98%, 95%CI 0.89~1.00) and high sensitivity (87%, 95%CI 0.71~0.95) for primary nodal staging in prostate cancer.[1] And 27% higher accuracy of PSMA PET compared to conventional, and strongly in favor of replacing bone scan and abdominal pelvic CT with PSMA PET/CT scans, for staging patients with high-risk PCa..

Also, there was consensus on the use of PSMA PET-CT for detecting local recurrences after radiation therapy, even at low PSA levels of <0.5 ng/ml. When these statements are considered against the current ASTRO Phoenix definition of biochemical recurrence after curative radiotherapy (which is defined as PSA nadir + 2 ng/ml) and the National Comprehensive Cancer Network 2023 guidelines, which accept restaging at PSA levels below 2 ng/ml only in young patients with rapidly increasing PSA. [2][3]

However, even Radelumin demonstrated a high detection rate for patients with BCR after radical prostatectomy and could improve patient management by correctly identifying sites of recurrence early in the course of the disease by its alternate route of excretion which bypasses the urinary tract. It still requires the assistance of mpMRI for lesions size of 1 mm or needed other methods to access identify benign or malignant in equivocal lesions.

There are many known references proving that comparing the signal intensity performance and proportional relationship between Choline and Citrate through the CSI categories of Chemical Shift Imaging (CSI) MRS can be used to identify benign and malignant (> 0.5: suspicious, > 0.8: very suspicious, > 2: abnormal). [4] In this article, we try to use the Radelumin (F-18 PSMA-1007) combined with MRS to identify and distinguish the equivocal lesion, Our method is initially effective, and we will collect more data to verify the feasibility of this method.