The differential diagnostic value of dual-phase 18F-DCFPyL PET/CT in prostate carcinoma

Abstract

Objective Binding of 18F-DCFPyL at prostate cancer (PC) cells increases over time. The dual-phase protocol may be helpful in separating benign lesions from malignant ones associated with prostate cancer. The purpose of this study was to retrospectively analyze the incremental diagnostic value of 18F-DCFPyL dual-time imaging in patients with prostate cancer. Method 114 prostate-related malignant lesions and 43 benign lesions in 38 patients with prostate cancer were retrospectively analyzed. Maximum standardized uptake value (SUVmax) for benign and prostate-related malignant lesions were calculated at min 60 and min 120 of PET/CT imaging. In order to calculate SUV ratio, the SUVmax of left gluteus maximus was measured at the same time. The difference of SUVmax metrics and SUV ratio between malignant and benign lesions was statistically analyzed, the cut-off value of ROC curve was calculated, and the diagnostic efficacy of SUVmax index and SUV ratio at two time points was compared. Results SUVmax metrics and SUV ratio of early and delayed imaging of PC-related malignant lesions were significantly higher than those of benign lesions (p < 0.05). In terms of individual indicators, the highest accuracy and sensitivity was in the delayed SUV ratio (89.2% and 94.7%), the best specificity was in the early SUVmax (93.0%). When the individual and combined indicators were compared together, the SUV ratio in the delay period still showed the best diagnostic sensitivity and accuracy, and the best specificity were SUVmax early and ▵SUVmax, SUVmax early and RI. Conclusions Uptake of 18F-DCFPyL increased over time in prostate-associated malignant lesions compared with benign tissue. For single-phase imaging, 2-hour (delayed) imaging has better diagnostic performance. However, the dual-phase imaging (1 and 2 h) are helpful in the differential diagnosis of prostate-associated malignant lesions and benign lesions.

Re: ‘Prostate‐specific membrane antigen positron emission tomography in addition to multiparametric magnetic resonance imaging and biopsies to select prostate cancer patients for focal therapy’

“…However, we believe that, despite the increasing claim of PSMA-PET as a more accurate method, it suffers from excess sensitivity, and its use should be directed towards patients with a high risk of metastatic PCa, particularly when the traditional imaging is controversial or in doubt. [3,4]. Until further studies confirm its validity in this setting, we support the importance to focus on improving the diagnostic accuracy of mpMRI through standardising report interpretation, incorporating artificial intelligence, and centralising the execution of the method within high-volume hospital centres [3][4][5] rather than adding new possible imaging modalities with their own limitations.…”

“…[3,4]. Until further studies confirm its validity in this setting, we support the importance to focus on improving the diagnostic accuracy of mpMRI through standardising report interpretation, incorporating artificial intelligence, and centralising the execution of the method within high-volume hospital centres [3][4][5] rather than adding new possible imaging modalities with their own limitations.…”

“…These data confirm the positions of European guidelines, which define PSMA-PET as highly accurate for disease staging but recommend against modifying the planned treatment based on its results. Therefore, the benefits of using PSMA-PET for the primary diagnosis of csPCa remain uncertain in the light of current evidence, and further extensive research on the topic is necessary [3].…”

Ga-68-PSMA-11 PET/CT in Patients with Biochemical Recurrence of Prostate Cancer after Primary Treatment with Curative Intent—Impact of Delayed Imaging

“…For other tracers, such as F-18-DCFPyL and F-18-PSMA-1007, images at 120 min after injection presented a higher detection rate of prostate cancer characteristic lesions than images at 60 min after injection. A recently published paper with F-18-DCFPyL confirmed that dual-phase imaging is useful in the differential diagnosis of malignant lesions and benign lesions [ 44 ].…”

Test Research versus Diagnostic Research: Clinical Application and Interpretation

“…Many published diagnostic studies are better characterized as test research than as diagnostic research [1]. Often these studies include a group of patients with the target disease and a group of patients without this disease in whom the results of the index test are also measured.…”