Despite substantial improvement in the definitive management of primary prostate cancer, a significant number of patients experience biochemical recurrence—a clinical state in which serum prostate-specific antigen (PSA) levels rise prior to the development of physical signs or symptoms. The early detection and localization of biochemical recurrence may confer eligibility for salvage therapy; therefore, imaging techniques that provide accurate disease visualization are imperative. In this review, we discuss various imaging methods for localizing disease in the context of biochemical recurrence in prostate cancer. Particularly, we describe available or investigational positron emission tomography (PET) radiotracers, such as18F-FDG,18F-NaF, choline (both18F and11C), the18F-labeled amino acid derivative fluciclovine, prostate-specific membrane antigen (PSMA) radioligands, and the short peptide compound bombesin. Generally, PET radiotracers such as18F-FDG,18F-NaF, and18F/11C choline have fallen out of favor because of their inferior sensitivity and/or specificity in relation to more recently developed radiotracers.18F-fluciclovine has addressed these shortcomings by exploiting the upregulation of amino acid transporters in tumors; however, PSMA-targeting agents have significantly advanced the management of biochemical recurrence of prostate cancer through their high sensitivity and specificity, enabling the identification of candidates for radionuclide therapy. Investigational agents, such as bombesin-based radiotracers, may address the shortcomings of treating prostate cancer with little to no PSMA expression.
尽管原发性前列腺癌的根治性治疗已取得显著进展，仍有大量患者经历生化复发——这是一种在出现体征或症状前血清前列腺特异性抗原（PSA）水平升高的临床状态。早期发现并定位生化复发可能使患者获得挽救性治疗资格；因此，提供准确疾病可视化信息的影像学技术至关重要。本综述探讨了前列腺癌生化复发背景下用于疾病定位的各种影像学方法。特别阐述了现有或研究中的正电子发射断层扫描（PET）放射性示踪剂，包括18F-FDG、18F-NaF、胆碱类示踪剂（18F与11C标记）、18F标记氨基酸衍生物氟环素、前列腺特异性膜抗原（PSMA）放射性配体，以及短肽化合物蛙皮素。总体而言，18F-FDG、18F-NaF及18F/11C胆碱等传统PET示踪剂因相较于新型示踪剂敏感性及/或特异性不足而逐渐被边缘化。18F-氟环素通过靶向肿瘤中上调的氨基酸转运蛋白改善了这些缺陷；然而PSMA靶向制剂凭借其高敏感性与特异性，显著推进了前列腺癌生化复发的诊疗进程，并能筛选适合放射性核素治疗的患者。基于蛙皮素的研究性示踪剂等新型制剂，则有望解决PSMA低表达或不表达前列腺癌的治疗难题。
肿瘤(癌症)患者之家