Cíl: Zhodnotit zkušenosti s prováděním PET/ CT a PET/MR s podáním 68Ga-PSMA-11 u nemocných v diagnostice karcinomu prostaty se zaměřením na rozdíly v indikacích PET|/CT a PET/MR, dále se zaměřením na logistiku a bezpečnost vyšetření a zařazení vyšetření do diagnostických algoritmů u primární diagnostiky karcinomu prostaty. Metodika: Od ledna 2018 do prosince 2020 bylo provedeno celkem 500 vyšetření u 449 mužů s podáním 68Ga-PSMA-11 pomocí PET/ CT (200 vyšetření) a PET/MR (300 vyšetření). Vyšetření byla prováděna po podání 68Ga-PSMA-11 v dávce aktivity 1, 25 MBq/kg hmotnosti s použitím jak PET/CT, tak PET/MR. V případě PET/CT byla prováděna vyšetření v rozsahu trupu a hlavy, pouze v případě vyšetření z důvodu biochemického relapsu a před zvážením terapie radioligandem PSMA 177-lutecia byla prováděna celotělová vyšetření, PET/MR vyšetření u nemocných, u nichž nebyla provedená radikální prostatektomii, bylo nejprve provedeno cílené vyšetření pánve, poté doplněno vyšetření trupu a hlavy. Výsledky: Při vyšetření nebyly prokázány závažné komplikace s relevancí k podání 68Ga-PSMA-11. Při vyšetření PET/CT byla nejčastější indikací vyšetření restaging při terapii (53 %, 106 vyšetření), následovaná stagingu (31 %, 62 vyšetření), naopak při vyšetření PET/MR dominovala indikace stagingu (67 %, 201 vyšetření)), restaging byl indikací jen ve 20 % (60 vyšetření). U obou modalit byly srovnatelné podobné podíly i absolutní počty vyšetření měla indikace u biochemického relapsu: u PET/CT 11 % (22 vyšetření) PET/MR 8 % (24 vyšetření). Závěr: 68Ga-PSMA-11 je bezpečné a spolehlivé radiofarmakum pro hodnocení stagingu, restagingu i hodnocení účinku terapie u nemocných s karcinomem prostaty, při shodné dostupnosti obou metod je preferovanou indikací PET/MR v případě stagingu co do absolutního počtu i podílu vyšetření, naproti tomu PET/CT je preferováno u nemocných vyšetřených v indikacích kontroly efektu terapie při restagingu onemocnění.

Aim: To assess the experience with the PET/MRI and PET/CT with the application of 68Ga-PSMA-11 in patients with diagnostics of prostatic carcinoma, the assessment targeted the logistic, safety, and the inclusion of 68Ga-PSMA-11 into the diagnostic work-up. Method: 500 examinations with the application of 68Ga-PSMA-11 were performed between January 2018 and December 2020, there were 200 of PET/CT and 300 of PET/MRI in 449 male patients, in 43 of them were performed multiple examinations. 68Ga-PSMA-11 into was injected using activity dosing of 1.25 MBq per kilogram of body weight. PET/CT examinations were performed in the extent of trunk and head except those indicated to radioligand therapy or biochemical relapse, when it was used the whole-body examination. In PET/MRI, the targeted pelvic imaging was performed before the trunk and head examinations, with the exception of cases when the radical prostatectomy was used, then the targeted examination was targeted. Results: No serious complication related to the application of 68Ga-PSMA-11 were registered. In PET/CT, the most frequent indication was restaging during therapy (53%, 106 cases), followed by the staging examination (31%, 62 examinations), in opposite PET/MRI was indicated most often due to the staging (67%, 201 examinations), restaging in 20% (60 examinations), respectively. The ration of particular examinations and also percentage was almost equal in indication of biochemical relapse (PET/CT in 22 cases, 11%, PET/MRI in 8%, 24 examinations). Conclusion: 68Ga-PSMA-11 is safe and valuable radiopharmaceutical in staging, restaging and assessment of the therapy response in patients with prostatic carcinoma. When the availability of PET/CT and PET/MRI is the equal, PET/MRI is preferred in staging of the disease, in opposite side, PET/CT in the assessment of the effect of therapy or restaging.

Cíl: První hodnocení zkušeností s podáním 68Ga-PSMA-11 z hlediska tolerance a vývoje renálních a jaterních funkcí a z hlediska kvality zobrazení. Metodika: Bylo hodnoceno celkem 20 mužů po podání 68Ga-PSMA-11, kdy deset vyšetření bylo provedeno pomocí PET/CT a deset vyšetření pomocí PET/MR. U nemocných byly sledovány vitální funkce během aplikace a vývoj hodnot kreatininu, urey, AST a ALT v séru s odstupem 1 týdne po podání látky. Výsledky: V jednotýdenním periprocedurálním období po podání radiofarmaka nebyly zaznamenány významné závažné nežádoucí reakce, u dvou nemocných došlo k mírné elevaci kreatininu nad horní mez normálních hodnot a u jednoho nemocného k elevaci již zvýšených hodnot AST. Nedošlo ke změnám vitálních hodnot. Ve všech případech byla diagnostická kvality vyšetření dostatečná. Závěr: První zkušenosti s podáním 68Ga-PSMA-11 ukazují, že nevyvolává bezprostřední změny vitálních hodnot, u jednotlivých případů může dojít v souvislosti s vlastním onemocněním k elevaci renálních nebo jaterních testů.

Aim: Early evaluation of the experience with the application of 68Ga-PSMA-11 in the relation to the tolerance and the evolution of the renal and liver laboratory tests, and in relation to the quality of imaging. Methods: The sample of 20 males was evaluated, 10 using PET/CT and 10 using PET/MRI. The vital functions during application and than the evolution of the laboratory serum levels of urea, creatinine, AST and ALT were evaluated within one week after radiopharmaceutical applications. Results: During one-week periprocedural period after radiopharmaceutcal application, there were not noted serious adverse events, in two ptients there were elevated serum creatinine levels above the upper treshold of normal values, in one patient also elevation of AST (previously yet elevated). No application related changes of vital values were noted. All imaging was considered as sufficient for evaluation. Conclusion: Early experience with the application of 68Ga-PSMA-11 shows, that it does not induce changes of vital values, but in individual cases, there could be noted the changes in renal or liver blood tests, due to the realtion with the own disease development.

• MeSH
• antigeny povrchové MeSH
• glutamátkarboxypeptidasa II metabolismus   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• metastázy nádorů diagnostické zobrazování   MeSH
• monitorování fyziologických funkcí metody   MeSH
• nádory prostaty * diagnostické zobrazování   MeSH
• pozitronová emisní tomografie MeSH
• radiofarmaka aplikace a dávkování   metabolismus   MeSH
• radioizotopy galia metabolismus   MeSH
• senzitivita a specificita MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

• Publikační typ
• abstrakt z konference MeSH

BACKGROUND: Positron Emission Tomography-Computed Tomography using Prostate-Specific Membrane Antigen (PSMA PET/CT) is notable for its superior sensitivity and specificity in detecting recurrent PCa and is under investigation for its potential in pre-treatment staging. Despite its established efficacy in nodal and metastasis staging in trial setting, its role in primary staging awaits fuller validation due to limited evidence on oncologic outcomes. This systematic review and meta-analysis aims to appraise the diagnostic accuracy of PSMA PET/CT compared to CI for comprehensive PCa staging. METHODS: Medline, Scopus and Web of science databases were searched till March 2023. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. Primary outcomes were specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of PSMA PET/CT for local, nodal and metastatic staging in PCa patients. Due to the unavailability of data, a meta-analysis was feasible only for detection of seminal vesicles invasion (SVI) and LNI. RESULTS: A total of 49 studies, comprising 3876 patients, were included. Of these, 6 investigated accuracy of PSMA PET/CT in detection of SVI. Pooled sensitivity, specificity, PPV and NPV were 42.29% (95%CI: 29.85-55.78%), 87.59% (95%CI: 77.10%-93.67%), 93.39% (95%CI: 74.95%-98.52%) and 86.60% (95%CI: 58.83%-96.69%), respectively. Heterogeneity analysis revealed significant variability for PPV and NPV. 18 studies investigated PSMA PET/CT accuracy in detection of LNI. Aggregate sensitivity, specificity, PPV and NPV were 43.63% (95%CI: 34.19-53.56%), 85.55% (95%CI: 75.95%-91.74%), 67.47% (95%CI: 52.42%-79.6%) and 83.61% (95%CI: 79.19%-87.24%). No significant heterogeneity was found between studies. CONCLUSIONS: The present systematic review and meta-analysis highlights PSMA PET-CT effectiveness in detecting SVI and its good accuracy in LNI compared to CI. Nonetheless, it also reveals a lack of high-quality research on its performance in clinical T staging, extraprostatic extension and distant metastasis evaluation, emphasizing the need for further rigorous studies.

• MeSH
• antigeny povrchové MeSH
• glutamátkarboxypeptidasa II * metabolismus   MeSH
• lidé MeSH
• nádory prostaty * patologie   diagnostické zobrazování   MeSH
• PET/CT * metody   MeSH
• senzitivita a specificita MeSH
• staging nádorů * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• přehledy MeSH
• systematický přehled MeSH

Functional imaging with prostate-specific membrane antigen (PSMA) ligands has emerged as the standard imaging method for prostate cancer (PCA). In parallel, the analysis of blood-derived, cell-free DNA (cfDNA) has been shown to be a promising quantitative biomarker of PCA aggressiveness and patient outcome. This study aimed to evaluate the relationship and prognostic value of cfDNA concentrations and the PSMA-positive tumor volume (PSMA-TV) in men with PCA undergoing [68Ga]Ga-PSMA-11 PET/CT imaging. Methods: We recruited 148 men with histologically proven PCA (mean age, 70.7 ± 7.7 y) who underwent [68Ga]Ga-PSMA-11 PET/CT (184.9 ± 18.9 MBq) and blood sampling between March 2019 and August 2021. Among these, 74 (50.0%) had hormone-sensitive PCA and 74 (50.0%) had castration-resistant PCA (CRPC). All patients provided written informed consent before blood sample collection and imaging. The cfDNA was extracted and quantified, and PSMA-expressing tumor lesions were delineated to extract the PSMA-TVs. The Spearman coefficient assessed correlations between PSMA-TV and cfDNA concentrations and cfDNA's relation with clinical parameters. The Kruskal-Wallis test examined the mean cfDNA concentration differences based on PSMA-TV quartiles for significantly correlated patient groups. Log-rank and multivariate Cox regression analyses evaluated the prognostic significance of high and low cfDNA and PSMA-TV levels for overall survival. Results: Weak positive correlations were found between cfDNA concentration and PSMA-TV in the overall group (r = 0.16, P = 0.049) and the CRPC group (r = 0.31, P = 0.007) but not in hormone-sensitive PCA patients (r = -0.024, P = 0.837). In the CRPC cohort, cfDNA concentrations significantly differed between PSMA-TV quartiles 4 and 1 (P = 0.002) and between quartiles 4 and 2 (P = 0.016). Survival outcomes were associated with PSMA-TV (P < 0.0001, P = 0.004) but not cfDNA (P = 0.174, P = 0.12), as per the log-rank and Cox regression analysis. Conclusion: These findings suggest that cfDNA might serve as a biomarker of advanced, aggressive CRPC but does not reliably reflect total tumor burden or prognosis. In comparison, [68Ga]Ga-PSMA-11 PET/CT provides a highly granular and prognostic assessment of tumor burden across the spectrum of PCA disease progression.

• MeSH
• biologické markery MeSH
• EDTA MeSH
• hormony MeSH
• izotopy gallia MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory prostaty rezistentní na kastraci * diagnostické zobrazování   MeSH
• nádory prostaty * diagnostické zobrazování   patologie   MeSH
• PET/CT metody   MeSH
• prognóza MeSH
• prospektivní studie MeSH
• radioizotopy galia MeSH
• retrospektivní studie MeSH
• senioři MeSH
• tumor burden MeSH
• volné cirkulující nukleové kyseliny * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Circulating-tumor DNA (ctDNA) and prostate-specific membrane antigen (PSMA) ligand positron-emission tomography (PET) enable minimal-invasive prostate cancer (PCa) detection and survival prognostication. The present study aims to compare their tumor discovery abilities and prognostic values. METHODS: One hundred thirty men with confirmed PCa (70.5 ± 8.0 years) who underwent [68Ga]Ga-PSMA-11 PET/CT (184.8 ± 19.7 MBq) imaging and plasma sample collection (March 2019-August 2021) were included. Plasma-extracted cell-free DNA was subjected to whole-genome-based ctDNA analysis. PSMA-positive tumor lesions were delineated and their quantitative parameters extracted. ctDNA and PSMA PET/CT discovery rates were compared, and the prognostic value for overall survival (OS) was evaluated. RESULTS: PSMA PET discovery rates according to castration status and PSA ranges did differ significantly (P = 0.013, P < 0.001), while ctDNA discovery rates did not (P = 0.311, P = 0.123). ctDNA discovery rates differed between localized and metastatic disease (P = 0.013). Correlations between ctDNA concentrations and PSMA-positive tumor volume (PSMA-TV) were significant in all (r = 0.42, P < 0.001) and castration-resistant (r = 0.65, P < 0.001), however not in hormone-sensitive patients (r = 0.15, P = 0.249). PSMA-TV and ctDNA levels were associated with survival outcomes in the Logrank (P < 0.0001, P < 0.0001) and multivariate Cox regression analysis (P = 0.0023, P < 0.0001). CONCLUSION: These findings suggest that PSMA PET imaging outperforms ctDNA analysis in detecting prostate cancer across the whole spectrum of disease, while both modalities are independently highly prognostic for survival outcomes.

• MeSH
• cirkulující nádorová DNA * krev   genetika   MeSH
• EDTA * analogy a deriváty   MeSH
• izotopy gallia * MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory prostaty * diagnostické zobrazování   genetika   krev   MeSH
• oligopeptidy MeSH
• PET/CT * MeSH
• prognóza MeSH
• průřezové studie MeSH
• radioizotopy galia * MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND: To validate the clinical utility of a previously identified circulating tumor DNA methylation marker (meth-ctDNA) panel for disease detection and survival outcomes, meth-ctDNA markers were compared to PSA levels and PSMA PET/CT findings in men with different stages of prostate cancer (PCa). METHODS: 122 PCa patients who underwent [68Ga]Ga-PSMA-11 PET/CT and plasma sampling (03/2019-08/2021) were analyzed. cfDNA was extracted, and a panel of 8 individual meth-ctDNA markers was queried. PET scans were qualitatively and quantitatively assessed. PSA and meth-ctDNA markers were compared to PET findings, and their relative prognostic value was evaluated. RESULTS: PSA discriminated best between negative and tumor-indicative PET scans in all (AUC 0.77) and hormone-sensitive (hsPC) patients (0.737). In castration-resistant PCa (CRPC), the meth-ctDNA marker KLF8 performed best (AUC 0.824). CHST11 differentiated best between non- and metastatic scans (AUC 0.705) overall, KLF8 best in hsPC and CRPC (AUC 0.662, 0.85). Several meth-ctDNA markers correlated low to moderate with the tumor volume in all (5/8) and CRPC patients (6/8), while PSA levels correlated moderately to strongly with the tumor volume in all groups (all p < 0.001). CRPC overall survival was independently associated with LDAH and PSA (p = 0.0168, p < 0.001). CONCLUSION: The studied meth-ctDNA markers are promising for the minimally-invasive detection and prognostication of CRPC but do not allow for clinical characterization of hsPC. Prospective studies are warranted for their use in therapy response and outcome prediction in CRPC and potential incremental value for PCa monitoring in PSA-low settings.

• MeSH
• cirkulující nádorová DNA genetika   krev   MeSH
• EDTA analogy a deriváty   MeSH
• izotopy gallia * MeSH
• lidé středního věku MeSH
• lidé MeSH
• metylace DNA * genetika   MeSH
• nádorové biomarkery * genetika   krev   MeSH
• nádory prostaty rezistentní na kastraci genetika   krev   diagnostické zobrazování   MeSH
• nádory prostaty * genetika   krev   diagnostické zobrazování   MeSH
• PET/CT * metody   MeSH
• prognóza MeSH
• prostatický specifický antigen * krev   genetika   MeSH
• průřezové studie MeSH
• radioizotopy galia * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

• Publikační typ
• abstrakt z konference MeSH

BACKGROUND: 68 Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) is a recommended imaging modality for patients with recurrent prostate cancer (PCa). Its routine implementation before radical prostatectomy (RP) may allow avoiding undertreatment. We aimed to analyze the diagnostic accuracy of 68 Ga-PSMA-PET/CT for pelvic lymph node metastases in a large cohort of patients treated with RP and extended pelvic lymph node dissection (ePLND) for high-risk PCa. METHODS: This is a retrospective analysis of an institutional database of patients who underwent 68 Ga-PSMA-PET/CT before RP and ePLND for high-risk PCa. The diagnostic estimates of 68 Ga-PSMA-PET/CT with 95% confidence intervals (CIs) for lymph node involvement were calculated. RESULTS: We included 165 high-risk PCa patients. The median PSA value was 24.5 ng/mL (range: 6.7-185) and all the patients had biopsy Grade Group 4-5. In total, 46 (28%) of patients had clinical lymph node involvement at 68 Ga-PSMA-PET/CT. A mean number of resected lymph nodes per patient was 22 (range: 15-45) and 149 (4.2%) of all resected nodes were positive for lymph node metastasis at final pathology. The diagnostic estimates for the detection of pN+ disease at RP were as follows: sensitivity 63% (95% CI: 51-75), specificity 97% (95% CI: 91-99), positive predictive value 94% (95% CI: 82-99), and negative predictive value 79% (95% CI: 70-86). The total accuracy of PSMA-PET was 83% (95% CI: 76-88). CONCLUSION: Our analyses support high specificity and positive predictive value of pretreatment 68 Ga-PSMA PET/CT for the detection of pelvic lymph node metastasis in patients treated with RP for high-risk PCa. While a positive finding should be considered as robust indicator for clinical decision-making, a negative result cannot reliably rule out the presence of lymph node involvement in high-risk PCa; there is a need for advanced risk stratification in those patients.

• MeSH
• lidé MeSH
• lokální recidiva nádoru patologie   MeSH
• lymfatické metastázy diagnostické zobrazování   patologie   MeSH
• nádory prostaty * diagnostické zobrazování   chirurgie   patologie   MeSH
• PET/CT * metody   MeSH
• prostata diagnostické zobrazování   chirurgie   patologie   MeSH
• prostatektomie MeSH
• radioizotopy galia MeSH
• retrospektivní studie MeSH
• staging nádorů MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Publikační typ
• souhrny MeSH