F-18-PSMA-1007 PET影像於初診斷高風險攝護腺癌之分期與治療影響

黃昱凱¹, 魏子鈞^1,5, 黃志賢^1,5, 張延驊^1,5, 鍾孝仁^1,5, 林志杰^1,5, 黃子豪^1,5 ,

陳威任^1,5, 劉裕明², 康鈺玫², 沈書慧³, 林可瀚⁴, 王昱豐⁴, 黃逸修^1,5

¹泌尿部, ²重粒子及放射腫瘤部, ³影像診療部, ⁴核醫部

臺北榮民總醫院

⁵書田泌尿科學研究中心 國立陽明交通大學醫學院泌尿學科

Staging and Therapeutic Impact of F-18-PSMA-1007 PET Imaging in Newly Diagnosed High-Risk Prostate Cancer

Yu-Kai Huang¹, Tzu-Chun Wei^1,5, William J. Huang^1,5, Yen-Hwa Chang^1,5,

Hsiao-Jen Chung^1,5, Chih-Chieh Lin^1,5,6, Tzu-Hao Huang^1,5,6, Wei-Jen Chen^1,5,6,

Yu-Ming Liu², Yu-Mei Kang², Shu-Huei Shen³, Ko-Han Lin⁴, Yuh-Feng Wang⁴, Eric Yi-Hsiu Huang^1,5,6

¹Department of Urology, ²Department of Heavy Particles & Radiation Oncology, ³Department of Radiology, ⁴Department of Nuclear Medicine,

Taipei Veterans General Hospital

⁵Department of Urology, School of Medicine and Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose: PSMA PET/CT provides superior accuracy over conventional imaging for initial staging in high-risk prostate cancer. However, intense urinary tracer activity may obscure pelvic lesions and reduce diagnostic confidence. F-18-PSMA-1007, characterized by minimal urinary excretion, offers improved detection of extraprostatic extension (EPE), seminal vesicle invasion (SVI), and nodal metastasis, particularly when integrated with MRI. This study evaluated the staging performance and therapeutic impact of F-18-PSMA-1007 PET imaging – including PET/CT and PET/MRI, in newly diagnosed high-risk prostate cancer.

Materials and Methods: We retrospectively analyzed 18 consecutive patients with high-risk prostate cancer (per EAU criteria) who underwent F-18-PSMA-1007 PET imaging between 2021–2024. Among them, 14 received PET/MRI and 4 underwent PET/CT, with PET/MRI preferred when detailed pelvic staging was clinically prioritized. Staging based on conventional CT and/or MRI was compared with PSMA PET findings. Changes in clinical staging and management intent were recorded and analyzed.

Results: The mean age was 67.4 ± 5.0 years (58-77), and mean PSA was 86.6 ± 119.6 ng/ml (7-333). Initial clinical staging was T2 (22.2%), T3a (50.0%), T3b (11.1%), and T4 (16.7%). PSMA PET modified the clinical stage in 55.6% (10/18) of patients - upstaging in 33.3% (6/18) and downstaging in 22.2% (4/18). Staging modification occurred more frequently in PET/MRI (57.1%) than PET/CT (50.0%). Upstaging was attributed to detection of new nodal (n=2) or bone metastasis (n=2), SVI (n=1), and bladder-neck invasion with bone metastasis (n=1). Downstaging resulted from exclusion of false-positive nodal (n=3) or bone lesions (n=1) on conventional imaging. Treatment intent changed in 55.6% (10/18): 3 patients initiated systemic therapy due to new metastasis, 2 shifted to radiotherapy + ADT for PET-confirmed N1 disease, 1 received neoadjuvant ADT followed by carbon-ion radiotherapy, and 4 proceeded to radical prostatectomy alone after false-positive nodal disease was excluded.

Conclusions:

F-18-PSMA-1007 PET imaging improved pelvic lesion detection and staging confidence, leading to clinically meaningful management changes in over half of high-risk prostate cancer patients. These findings support its role as a comprehensive and effective “one-stop” modality for initial staging in aggressive prostate cancer. Larger prospective studies with pathologic correlation are warranted.