为了评估在高风险病例中使用前列腺特异性膜抗原（PSMA）正电子发射断层显像（PET）/计算机断层扫描（CT）作为单一影像模态来引导靶向活检和检测临床意义重大的前列腺癌（csPCa）的诊断路径的可行性，本前瞻性、非随机队列研究对60名前列腺特异性抗原（PSA）水平为20-50 ng/ml的患者进行了18 F-PSMA(DCFPyL)-PET/CT检查之后进行前列腺活检。MRI影像学检查未进行。使用前列腺12节段分块模型，在靶向PSMA活检与常规活检同时进行。评估了靶向与常规活检以及单纯靶向活检对前列腺癌和csPCa的检出率。csPCa被定义为国际泌尿病理学学会（ISUP）等级≥2的前列腺活检。所有PSMA PET/CT检查中观察到前列腺内可疑PCa病灶。60名患者中有27名（45%）已经有转移性疾病。 联合PSMA靶向与常规活检在56/60（93.3%）患者中检出了前列腺癌，其中52例（92.9%）为csPCa。如果作为单一活检模态进行，靶向PSMA引导活检在60名患者中检出了52例（86.7%）前列腺癌并在27例有转移的患者中（100%）全部检出。 在高风险前列腺癌的活检纯净患者中，使用基于PSMA的单一影像模态途径可以避免大量诊断性MRI扫描，同时获得足够的靶向、分期和csPCa检测。版权所有，未经授权不得转载。

To assess whether a diagnostic pathway in which Prostate-specific membrane antigen (PSMA) positron-emission tomography (PET)/CT is used as single imaging modality is feasible to guide targeted biopsy and to detect clinically significant prostate cancer (csPCa) in biopsy-naïve men at high-risk of disease.Sixty men with a prostate-specific antigen (PSA)-level of 20-50 ng/ml underwent 18 F-PSMA(DCFPyL)-PET/CT prior to prostate biopsies in this prospective, non-randomized cohort study. MRI-imaging was not performed. Using a 12-segment mapping model of the prostate, targeted PSMA-biopsy was performed along with systematic biopsies. The detection rate for PCa and for csPCa was assessed for combined systematic and targeted biopsy and for targeted biopsy only. csPCa was defined as a prostate biopsy with an International Society of Uropathology (ISUP) grade ≥2.Lesions suspicious for PCa in the prostate gland were observed on all PSMA PET/CT. A total of 27/60 men (45%) already had metastatic disease on staging 18 F-PSMA(DCFPyL)-PET/CT. Combined PSMA-targeted and systematic biopsies detected PCa in 56/60 (93.3%) patients with 52 of them (92.9%) having csPCa. Targeted PSMA-guided biopsy, if performed as a single biopsy modality, identified PCa in 52/60 men (86.7%) and in 27/27 men (100%) men with metastases.Using the PSMA-driven single imaging modality pathway in biopsy-naïve men at high-risk of PCa, a substantial number of diagnostic MRI scans could be avoided while at the same time obtaining adequate targeting, staging, and detection of csPCa.This article is protected by copyright. All rights reserved.