Early lesion detection with 18F-DCFPyL PET/CT in 248 patients with biochemically recurrent prostate cancer

Abstract

Purpose Prostate-specific membrane antigen (PSMA) PET/CT is increasingly used in patients with biochemically recurrent prostate cancer (BCR), mostly using gallium-68 ( 168 Ga)-labelled radiotracers. Alternatively, fluorine-18 ( 18 F)-labelled PSMA tracers are available, such as 18 F-DCFPyL, which offer enhanced image quality and therefore potentially increased detection of small metastases. In this study we evaluate the lesion detection efficacy of 18 F-DCFPyL PET/CT in patients with BCR and determine the detection efficacy as a function of their PSA value. Methods A total of 248 consecutive patients were evaluated and underwent scanning with 18 F-DCFPyL PET/CT for BCR between November 2016 and 2018 in two hospitals in the Netherlands. Patients were examined after radical prostatectomy (52%), external-beam radiation therapy (42%) or brachytherapy (6%). Imaging was performed 120 min after injection of a median dose of 311 MBq 18 F-DCFPyL. Results In 214 out of 248 PET/CT scans (86.3%), at least one lesion suggestive of cancer recurrence was detected (‘positive scan’). Scan positivity increased with higher PSA values: 17/29 scans (59%) with PSA values <0.5 ng/ml; 20/29 (69%) with PSA 0.5 to <1.0 ng/ml; 35/41 (85%) with PSA 1.0 to <2.0 ng/ml; 69/73 (95%) with PSA 2.0 to <5.0 ng/ml; and 73/76 (96%) with PSA ≥5.0 ng/ml. Interestingly, suspicious lesions outside the prostatic fossa were detected in 39–50% of patients with PSA <1.0 ng/ml after radical prostatectomy (i.e. candidates for salvage radiotherapy). Conclusion 18 F-DCFPyL PET/CT offers early detection of lesions in patients with BCR, even at PSA levels <0.5 ng/ml. These results appear to be comparable to those reported for 68 Ga-PSMA and 18 F-PSMA-1007, with potentially increased detection efficacy compared to 68 Ga-PSMA for patients with PSA <2.0. Electronic supplementary material The online version of this article (10.1007/s00259-019-04385-6) contains supplementary material, which is available to authorized users.

Use of gallium‐68 prostate‐specific membrane antigen positron‐emission tomography for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: an overview of the current literature

“…Relevant manuscripts were found through searches of Medline, EMBASE and Science Direct databases. To review the sensitivity, specificity and positive predictive value of 68 Ga-PSMA PET, the following search terms were used: '(PSMA, 68 Ga-PSMA, 68 Gallium-PSMA, Ga-68-PSMA or prostate-specific membrane antigen)' in combination with '(histology, lymph node, staging, sensitivity, specificity or positive predictive value)'. To review the detection rate of 68 Ga-PSMA PET in patients with BCR after RP the following search terms were used: '(PSMA, 68 Ga-PSMA, 68 Gallium-PSMA, Ga-68-PSMA or prostate-specific membrane antigen)' in combination with '(recurrence, recurrent or detection)'.…”

“…Expression of PSMA is increased in more aggressive PCa [6]. Since the first report of the use of 68 Ga-PSMA PET in 2012, there has been a growing body of evidence that this technique is superior to other imaging approaches, both in the primary as well as in the recurrence setting [7,8]. 68 Ga-PSMA PET has demonstrated a significantly higher detection rate than choline PET/CT and a high overall impact on management [9].…”

“…Since the first report of the use of 68 Ga-PSMA PET in 2012, there has been a growing body of evidence that this technique is superior to other imaging approaches, both in the primary as well as in the recurrence setting [7,8]. 68 Ga-PSMA PET has demonstrated a significantly higher detection rate than choline PET/CT and a high overall impact on management [9]. The 2019 European Association of Urology guideline recommends performing a PSMA PET at early BCR (>0.2 ng/ mL) after initial treatment if the result will influence subsequent treatment decisions (level of evidence 2b; weak recommendation) [3].…”

“…The primary aim of the prsent review was to obtain insight into the sensitivity and specificity of 68 Ga-PSMA PET for the detection of pelvic lymph node metastases in patients with primary PCa. In addition, we aimed to evaluate the positive predictive value of 68 Ga-PMSA PET for the detection of lymph node metastases in patients with BCR after initial curative treatment.…”

“…The primary aim of the prsent review was to obtain insight into the sensitivity and specificity of 68 Ga-PSMA PET for the detection of pelvic lymph node metastases in patients with primary PCa. In addition, we aimed to evaluate the positive predictive value of 68 Ga-PMSA PET for the detection of lymph node metastases in patients with BCR after initial curative treatment. The secondary aim was to assess the detection rate of 68 Ga-PSMA PET in patients with BCR after radical prostatectomy (RP), the location of PCa recurrence and the impact of 68 Ga-PSMA PET outcome on the planning of salvage treatment in these patients.…”