摘要：攝護腺癌在台灣為男性第五順位的癌症，早期診斷攝護腺癌確認分期並給予正確的治療，可以顯著的提升病患的預後，但傳統影像學檢查如核磁共振對於淋巴結轉移的偵測效果不佳，骨骼掃描特異性不足，而正子掃描能提供功能性資訊提升診斷正確率。以鎵68標訂的prostate specific membrane antigen (PSMA, 68Ga-PSMA)正子造影能在prostate specific antigen (PSA)極低的情況下診斷攝護腺癌的復發，而在初始分期上68Ga-PSMA正子造影偵測原發腫瘤的能力與核磁共振相當，偵測淋巴結轉移的能力亦比傳統影像學檢查優異。然而鎵68半衰期僅68分鐘且需孳生器生產，限制了臨床上的轉移與使用。以氟18標訂的PSMA正子藥物可以大量生產且半衰期較長允許轉送，正子能量較低，造影品質可能較為良好，且泌尿道排泄少能更精準找出轉移淋巴結以及局部病灶所在。其中以氟18標訂之PSMA-1007在以往回溯性研究中顯示與68Ga-PSMA診斷效果相當，且能與治療性放射性同位素結合。本研究目的為完成18F-PSMA-1007之合成，並以前瞻式方式探討其在攝護腺癌的診斷能力，以及與目前主流之68Ga-PSMA正子造影比較。
Abstract: Prostate cancer is the 5th common male cancer in Taiwan. Early diagnosis and accurate staging is essential to planning therapy and improving prognosis. However, conventional imaging such as magnetic resonance imaging has low accuracy in detecting lymph node (LN) metastasis, and bone scan has limited specificity in detecting bone metastases. Gallium-68 labeled PSMA positron emission tomography (68Ga-PSMA PET) has been observed to be able to detect primary tumor as excellent as MRI, detect lymph node and bone metastasis better than conventional imaging studies, and detect pathological origin in biochemical recurrence with very low PSA level. Nevertheless, Ga-68 has short half-life (68 min) and was produced by generator, those have limited clinical utilization of 68Ga-PSMA. 18F-PSMA can overcome several limitations of 68Ga-PSMA: (1) F-18 is cyclotron produced and has longer half-life (119 min), which can be synthesized in greater amount and is transferable to a non-cyclotron PET center; (2) 18F-PSMA PET has better spatial resolution than Ga-68 PSMA due to lower positron range of F-18, (3) 18F-PSMA has better ability to identify pelvic LN due to low urinary excretion. Several retrospective studies have showed that 18F-PSMA-1007 PET has comparable diagnostic ability as 68Ga-PSMA PET and is able to label with therapeutic radioisotope. This prospective study aims to successfully synthesize 18F-PSMA-1007 in our laboratory and pursue its diagnostic ability compared to 68Ga-PSMA.