18F-DCFPyL PET/CT for primary staging in 160 high-risk prostate cancer patients; metastasis detection rate, influence on clinical management and preliminary results of treatment efficacy

Wondergem, Maurits; Zant, Friso M. van der; Broos, Wouter A M; Roeleveld, Ton A.; Donker, R; Oever, Diederik ten; Geenen, Remy W. F.; Knol, Remco J.J.

doi:10.1007/s00259-020-04782-2

Cited by 19 publications

(8 citation statements)

References 28 publications

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“…The incidence of bone metastases at staging of patients with newly diagnosed high risk PCa varies between 6.6-36.1% in different publications depending on the size of cohort and either SPECT or PET technology was used [4,[27][28][29][30][31][32]. Clinical guidelines [6-9], recommend performance of BS at staging when PSA is ≥20, clinical stage is T2 and PSA is ≥10 ng/dL, clinical stage is T3 or T4, Gleason score is ≥8, or any symptoms are suggestive of bone metastases.…”

Section: Discussionmentioning

confidence: 99%

Staging 68 Ga-PSMA PET/CT in 963 consecutive patients with newly diagnosed prostate cancer: incidence and characterization of skeletal involvement

Kesler

Kerzhner

Druckmann

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose: The aim of the study was to elaborate the incidence and type of skeletal involvement in a large cohort of patients with newly diagnosed prostate cancer (PCa) referred for Ga-68 PSMA-11 PET/CT staging in a single center. Methods: Study cohort included 963 consecutive patients with newly diagnosed PCa referred Ga-68 PSMA-11 PET/CT study for staging. The incidence of bone involvement, type of bone metastases, extent of disease were determined and correlated with the ISUP Grade Group (GG) criteria, and PSA levels.Results: Bone metastases were found in 188 (19.5%) of 963 patients. Osteoblastic type metastases were the most common type of bone metastases presented in 133 of the patients with malignant bone involvement (70.7%). Slightly more than half of them (54.1%) had "pure" osteoblastic lesions, while the other 45.9% had also intramedullary and/or osteolytic type lesions. Intramedullary metastases were found in 97 patients (51.6%), while 41 (21.8%) of them were "pure" intramedullary lesions. Osteolytic metastases were detected in 36 patients (19.2%), of which 8 were "pure" osteolytic lesions. Bone metastases were found in 10.7% of patients with PSA<10 ng/dL and in 27.4% of patients with PSA>10 ng/dL; in 6.1% of patients with GG≤2/3 and in 8.9% of patients with GG 4/5. In 7.6% of the patients, skeletal involvement was extensive, while 11.9% of patients had oligometastatic disease. Conclusion: Although traditionally bone metastases of PCa are considered osteoblastic; osteolytic and intramedullary metastases are common, as identi ed on PET with labeled-PSMA.

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Section: Discussionmentioning

confidence: 99%

Staging 68 Ga-PSMA PET/CT in 963 consecutive patients with newly diagnosed prostate cancer: incidence and characterization of skeletal involvement

Kesler

Kerzhner

Druckmann

et al. 2021

Eur J Nucl Med Mol Imaging

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“…Nevertheless, the main drawback is that in men undergoing radiotherapy, histologic confirmation of nodal disease was not performed, and some patients might have had microscopic disease that was missed by either conventional imaging or PSMA PET. Wondergem et al studied 160 high-risk patients at presentation with a fluorinated PSMA compound ( 18 F-DCFPyL) (26). PSMA PET correctly identified 81 of 90 (90%) patients with local or distant metastatic spread at final diagnosis.…”

Section: Stagingmentioning

confidence: 99%

Current and Emerging Clinical Applications of PSMA PET Diagnostic Imaging for Prostate Cancer

et al. 2021

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Prostate-specific membrane antigen (PSMA) is highly expressed on most prostate cancer (PCa) cells, and several PSMA ligands for PET imaging are now available worldwide. 68 Ga-PSMA-11 has already received U.S. Food and Drug Administration approval, and use of PSMA PET is currently suggested by several international guidelines for investigating PCa in different clinical settings. In primary PCa, PSMA PET has been shown to be superior to cross-sectional imaging for the detection of pelvic lymph nodes and distant metastases with subsequent clinical management changes. Additionally, it might also have a role in intraprostatic tumor localization, especially when combined with multiparametric MRI. In a setting of PCa recurrence, higher detection rates have been observed than for any other available imaging techniques, especially at low prostate-specific antigen values. Furthermore, PSMA PET consistently led to a shift in clinical management, thus increasing the proportion of radiotherapy, surgery, or other focal therapies at the expense of systemic options or no treatment. In oligometastatic disease after radical surgery, PSMA PET may be relevant in guiding a metastasis-directed therapy approach, as preliminary data seem to suggest a benefit in terms of progression-free survival after treatment of PSMA PET-positive lesions. As a staging and gatekeeping technique, PSMA PET represents a reliable wholebody imaging procedure in combination with second-line therapy of castration-resistant PCa, as well as being pivotal when assessing patients eligible for radioligand therapy such as 177 Lu-PSMA. This critical review aims at providing a comprehensive overview of the latest literature on the current or emerging main indications, as well as a general outlook on the recommended interpretation criteria for PSMA PET imaging.

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“…Despite its short period in clinical use, [ 18 F]DCFPyL has been evaluated in several studies. In patients with PSA values > 3.6 ng/mL, the diagnostic performance of [ 18 F]DCFPyL in the primary staging of PCa demonstrated a 51% detection rate for lymph node metastases (LNMs), a 56% detection rate for distant metastases, and a consequential influence on several patients’ treatment [ 95 ]. Moreover, approximately half of the LNMs that were positively detected by [ 18 F]DCFPyL did not show signs of lymph node enlargement on CT scans; therefore, [ 18 F]DCFPyL demonstrated better accuracy in the primary staging of PCa than did CT. [ 18 F]DCFPyL PET demonstrated superiority in comparison with conventional imaging for the staging of and treatment decision in PCa patients with recurrent or metastatic disease [ 90 ].…”

Section: Resultsmentioning

confidence: 99%

The Performance of FDA-Approved PET Imaging Agents in the Detection of Prostate Cancer

Zelchan

Orlova

2022

Biomedicines

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Positron emission tomography (PET) incorporated with X-ray computed tomography (PET/CT) or magnetic resonance imaging (PET/MRI) is increasingly being used as a diagnostic tool for prostate cancer (PCa). In this review, we describe and evaluate the clinical performance of some Food and Drug Administration (FDA)-approved agents used for visualizing PCa: [18F]FDG, [11C]choline, [18F]FACBC, [68Ga]Ga-PSMA-11, [18F]DCFPyL, and [18F]-NaF. We carried out a comprehensive literature search based on articles published from 1 January 2010 to 1 March 2022. We selected English language articles associated with the discovery, preclinical study, clinical study, and diagnostic performance of the imaging agents for the evaluation. Prostate-specific membrane antigen (PSMA)-targeted imaging agents demonstrated superior diagnostic performance in both primary and recurrent PCa, compared with [11C]choline and [18F]FACBC, both of which target dividing cells and are used especially in patients with low prostate-specific antigen (PSA) values. When compared to [18F]-NaF (which is suitable for the detection of bone metastases), PSMA-targeted agents were also capable of detecting lesions in the lymph nodes, soft tissues, and bone. However, a limitation of PSMA-targeted imaging was the heterogeneity of PSMA expression in PCa, and consequently, a combination of two PET tracers was proposed to overcome this obstacle. The preliminary studies indicated that the use of PSMA-targeted scanning is more cost efficient than conventional imaging modalities for high-risk PCa patients. Furthering the development of imaging agents that target PCa-associated receptors and molecules could improve PET-based diagnosis of PCa.

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18F-DCFPyL PET/CT for primary staging in 160 high-risk prostate cancer patients; metastasis detection rate, influence on clinical management and preliminary results of treatment efficacy

Cited by 19 publications

References 28 publications

Staging 68 Ga-PSMA PET/CT in 963 consecutive patients with newly diagnosed prostate cancer: incidence and characterization of skeletal involvement

Staging 68 Ga-PSMA PET/CT in 963 consecutive patients with newly diagnosed prostate cancer: incidence and characterization of skeletal involvement

Current and Emerging Clinical Applications of PSMA PET Diagnostic Imaging for Prostate Cancer

The Performance of FDA-Approved PET Imaging Agents in the Detection of Prostate Cancer

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