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目的:比较 68Ga-前列腺特异性膜抗原(PSMA)PET/CT与多参数磁共振(mpMRI)对初诊前列腺癌分期诊断的效能。 方法:回顾性分析2021年12月至2023年6月复旦大学附属肿瘤医院收治的30例前列腺癌患者的病例资料。中位年龄68(67，76)岁。前列腺特异性抗原(PSA)17.91(9.41，39.53)ng/ml。患者术前均接受 68Ga-PSMA PET/CT和mpMRI检查，两项检查中位间隔时间21.00(2.75，35.50)d。影像学检查共发现50处病灶。患者术前均经穿刺活检病理确诊为前列腺腺癌，均未接受任何抗肿瘤治疗。所有患者均接受根治性前列腺切除术，手术切除标本术后制作病理大切片。将术后病理大切片作为金标准，比较 68Ga-PSMA PET/CT与mpMRI在诊断前列腺癌包膜外侵犯(EPE)、精囊腺侵犯(SVI)，以及前列腺内肿瘤病灶方面的敏感性和特异性。 结果:本组30例，术后病理结果显示12例出现EPE，8例出现SVI。术前发现的50处病灶中，术后病理检查诊断为有临床意义前列腺癌病灶38处(76.0%)。将mpMRI、 68Ga-PSMA PET/CT检查图像与术后病理大切片行三重融合比较。 68Ga-PSMA PET/CT和mpMRI诊断EPE的敏感性分别为66.7%(8/12)和50.0%(6/12)( P＝0.500)，特异性分别为88.9%(16/18)和83.3%(15/18)( P＝1.000)；诊断SVI的敏感性分别为50.0%(4/8)和75.0%(6/8)( P＝0.687)，特异性分别为86.3%(19/22)和90.9%(20/22)( P＝1.000)；诊断有临床意义前列腺癌病灶的敏感性分别为89.5%(34/38)和63.2%(24/38)( P＝0.031)，特异性分别为50.0%(6/12)和33.3%(4/12)( P＝0.750)。 结论:68Ga-PSMA PET/CT诊断前列腺癌病灶的敏感性显著高于mpMRI，两种检查方法的特异性无显著差异。

Objective:To assess the diagnostic performance of 68Ga-PSMA PET/CT and mpMRI in initial staging of prostate cancer. Methods:A retrospective analysis was conducted on patients with initial diagnosis of prostate cancer who underwent prostatectomy at Fudan University Shanghai Cancer Center from December 2021 to June 2023. All had biopsy-confirmed prostate cancer preoperatively and had not undergone any anti-tumor treatment. Prior to surgery, all patients underwent 68Ga-PSMA PET/CT and mpMRI scans. The surgical samples were processed by whole-mount slides pathology. Thirty patients were included, with a median age of 68 years (range 67-76 years). The preoperative median PSA level was 17.91 ng/ml (range 9.41-39.53 ng/ml). The median interval between the two examinations was 21.00 days (range 2.75-35.50 days). Based on the postoperative whole-mount slides pathology which was the gold standard, we compared the sensitivity and specificity of 68Ga-PSMA PET/CT and mpMRI in diagnosing extraprostatic extension, seminal vesicle invasion, and intraprostatic tumor lesion. Results:According to the postoperative pathology, among the 30 patients, 12 had extraprostatic extension (EPE), 8 had seminal vesicle invasion (SVI). Among the 50 lesions found before surgery, postoperative pathology showed that 38 of them were clinically significant prostate cancer lesions (76.0%, 38/50). Using whole-mount pathology, preoperative mpMRI, and 68Ga-PSMA PET/CT imaging for triple fusion comparison, the sensitivity and specificity of 68Ga-PSMA PET/CT in diagnosing EPE were 66.7% (8/12) and 88.9% (16/18), respectively. The sensitivity and specificity of mpMRI in diagnosing EPE were 50.0% (6/12) and 83.3% (15/18), respectively. In diagnosing SVI, the sensitivity and specificity of 68Ga-PSMA PET/CT were 50.0% (4/8) and 86.3% (19/22), respectively. The sensitivity and specificity of mpMRI were 75.0% (6/8) and 90.9% (20/22), respectively. When diagnosing clinically significant tumor lesions within the prostate, the sensitivity of 68Ga-PSMA PET/CT was 89.5% (34/38), which was significantly better than the mpMRI of 63.2% (24/38), with no significant difference in specificity. Conclusions:The sensitivity of 68Ga-PSMA PET/CT in diagnosing intraprostatic lesions was significantly higher than that of mpMRI, with no significant difference in specificity.