Clinical verification of 18F-DCFPyL PET-detected lesions in patients with biochemically recurrent prostate cancer

Abstract

Radiolabeled Prostate-Specific Membrane Antigen (PSMA) PET/CT is the current standard-of-care for lesion detection in patients with biochemically recurrent (BCR) prostate cancer (PCa). However, rigorous verification of detected lesions is not always performed in routine clinical practice. To aid future 18 F-radiolabeled PSMA PET/CT interpretation, we aimed to identify clinical/imaging characteristics that increase the likelihood that a PSMAavid lesion is malignant. Materials and methods 262 patients with BCR, who underwent 18 F-DCFPyL PSMA PET/CT, were retrospectively analyzed. The malignant nature of 18 F-DCFPyL PET-detected lesions was verified through any of the following metrics: (1) positive histopathological examination; (2) additional positive imaging; (3) a �50% decrease in Prostate-Specific Antigen (PSA) following irradiation of the lesion(s). Results In 226/262 PET scans (86.3%) at least one lesion suspicious for recurrent PCa was detected ('positive scan'). In 84/226 positive scans (37.2%), at least one independent verification metric was available. PSMA PET-detected lesions were most often confirmed to be malignant (PCa) in the presence of a CT-substrate (96.5% vs. 55.6% without CT-substrate), with SUV peak �3.5 (91.4% vs. 60.0% with SUV peak <3.5), in patients with a PSA-level �2.0

[18F]DCFPyL PET/CT for Imaging of Prostate Cancer

“…Meijer et al reported 262 patients with biochemical recurrence (BCR) and performed clinical verification of imaging findings, including histopathology or decrease in prostate-specific antigen (PSA) serum levels after therapy. In 226/262 (86.3 %) of the patients, at least one lesion was identified on [ 18 F]DCFPyL PET/CT and diagnostic certainty increased in the presence of characteristic abnormalities on CT, with a peak SUV of ≥ 3.5, when PSA levels was more than 2.0 ng/mL or in patients with more than two PET-positive lesions [40]. Dietlein and coworkers conducted a comparative study using [ 18 F]DCFPyL and a 68 Ga-labeled PSMA equivalent in patients with BCR.…”

Piflufolastat F 18: Diagnostic First Approval

“…PSMA-PET-detected lesions were more frequently confirmed as malignant prostate cancer in patients with any of the following characteristics: PSA ≥ 2.0 ng/mL (83.7% vs 65.1% with PSA < 2.0 ng/mL; p = 0.03); corresponding findings detected on CT (96.5% vs 55.6% with no suspicious CT findings; p < 0.001); SUV max ≥ 3.5 (91.4% vs 60.06% with SUV max < 3.5; p < 0.001); >2 PET-positive lesions (94.1% vs 64.2% with 1 or 2 PET-positive lesions; p = 0.02) in a retrospective analysis of piflufolastat F 18 imaging data from 262 patients with BCR [25]. PSA levels were positively associated with piflufolastat F 18 PET/CT findings (95.7% of those with a PSA level > 2-5.0 ng/mL, 87.1% of those with a PSA level of > 0.5-2 ng/mL and 56.5% of those with a PSA level of ≤ 0.5 ng/mL), but not overall positive imaging and Gleason sum or PSA doubling time in patients with biochemically recurrent prostate cancer in an observational trial (NCT02825875; retrospective analysis) [26].…”

A Unique Core–Shell Structured, Glycol Chitosan-Based Nanoparticle Achieves Cancer-Selective Gene Delivery with Reduced Off-Target Effects

“…Conventional strategies to engage tumor cells with imaging or toxic warheads in vivo through cancer-specific markers, such as membrane receptors, metabolic enzymes, and structural protein targets, often provide a measure of undesired, off-target effects [7,[10][11][12][13]. Molecular-genetic imaging and therapy using reporter-probe pairs have been pursued in various ways for over two decades [14][15][16][17]. An advantage of the molecular-genetic approach over other theranostics is the capacity to produce the imaging and/or therapeutic agent specifically within the cancer cell, in situ, as the promoter activates production of these agents only when in contact with malignant tissues.…”