Pathological predictors of ¹⁸F‐DCFPyL prostate‐specific membrane antigen‐positive recurrence after radical prostatectomy

Abstract

To assess the correlation of pathological radical prostatectomy (RP) specimen features and prostate-specific antigen (PSA) characteristics to imaging findings on subsequent 18 F-DCFPyL positron emission tomography/computed tomography (PET/ CT) in patients with biochemical failure (BF). Patients and MethodsRetrospective analysis of combined 18 F-DCFPyL PET/CT database of patients from centres in Australia and New Zealand was performed. A total of 205 patients presenting with BF after RP were included in this study. Imaging findings on 18 F-DCFPyL PET/CT were recorded and correlated with the PSA characteristics at BF and pathological features of the original tumour. ResultsOf the 205 patients, 120 (58.5%) had evidence of abnormal prostate-specific membrane antigen (PSMA) expression compatible with recurrent prostate cancer. Increasing PSA velocity (P = 0.01), International Society of Urological Pathology (ISUP) Grade Group (P = 0.02), lymphovascular invasion (P = 0.05) and nodal positivity (P = 0.02) at the time of RP were more likely to demonstrate PSMA positivity. Multivariable logistic regression revealed a higher PSA level prior to PSMA PET/CT (P < 0.01), adjuvant radiotherapy (P = 0.09), Gleason score ≥8 (P < 0.01) and nodal positivity (P = 0.05) were all predictive of PSMA positivity. Conclusion18 F-DCFPyL PET/CT positivity, both generally and site specific, correlates with PSA and RP pathological factors. Our results echo cohorts focussing on post-RP patients, those imaged with 68 Ga-PSMA and those concerning biochemical persistence. Nomograms that include risk factors for 'PSMA-positive recurrence' in the BF population may increase the catchment of patients with disease confined to the prostate bed or pelvis who have a greater probability of prolonged disease-free survival.

Can 68Ga‐PSMA positron emission tomography and multiparametric MRI guide treatment for biochemical recurrence after radical prostatectomy?

“…However, 68 Ga-PSMA PET/CT has diagnostic limitations in detecting lesions below 4 mm and those near the bladder, due to urinary radiotracer excretion [18,21,24]. PSA dynamics and RP histopathological predictors of PSMA positivity have been identified, with both 18 F-DCFPyL and 68 Ga-PSMA [25].…”

Re‐defining 18F‐DCFPyl prostate‐specific membrane antigen positron emission tomography detected local recurrence from radical prostatectomy histopathology

“…Only 18% of patients with positive margins develop biochemical recurrence [12], making the relationship between margin status and local recurrence complex and unpredictable [16]. Historically, surgical margin status was thought to be a powerful prognostic factor [12] for the development and location of local recurrences; however, there is a growing body of literature that this may not be the case and that surgical margin status is not a sole indicator of prognosis [7]. Studies explore the cellular features of the tumour itself and how they will drive the prognosis.…”

“…PSMA PET can now even be used as a risk stratification tool, with PSMA-PET intensity correlating with clinically significant prostate cancer [5,6]. Previous studies have investigated the correlation between the characteristics of the original tumour and imaging findings on PSMA PET [7], but few studies have described the correlation between the topography of local recurrences on PSMA PET and the topography of lesions on RP histopathology.…”

Predictors of PSMA PET Positivity: Analysis in a Selected Cohort of Biochemical Recurrence Prostate Cancer Patients after Radical Prostatectomy

“…Patients showing BCR of PCa have a higher risk of developing distant metastases and PCa-related death [ 3 , 4 ]. Several clinical parameters including serum prostate-specific antigen (PSA) levels, PSA kinetics, and the International Society of Urological Pathology (ISUP) score have been shown to predict the risk of PCa recurrence after RP [ 5 , 6 , 7 , 8 ].…”