Diagnostic performance of 18F-DCFPyL positron emission tomography/computed tomography for biochemically recurrent prostate cancer and change-of-management analysis

  • Guillaume Chaussé Jewish General Hospital
  • Noah Ben-Ezra Jewish General Hospital
  • Michelle Stoopler
  • Jeremy Y. Levett https://orcid.org/0000-0003-2228-9557
  • Tamim Niazi
  • Maurice Anidjar
  • Gad Abikhzer
  • Stephan Probst
Keywords: PSMA PET; 18F-DCFPyL; PET/CT; Prostate cancer; biochemical recurrence

Abstract

Introduction: Conventional imaging (CI) performs poorly to identify sites of disease in biochemically recurrent prostate cancer. 68Ga-PSMA-11 positron emission tomography/ computed tomography (PET/CT) is most studied but has a very short half-life. This study reports the diagnostic performance of the novel prostate-specific membrane antigen (PSMA) radiotracer 18F-DCFPyL using real-life data and tumor board simulation to estimate the impact of (sup>18F-DCFPyL PET on patient management.

Methods: Ninety-three 18F-DCFPyL PET/CT scans performed for patients previously treated for prostate cancer with a rising prostate-specific antigen (PSA) were retrospectively compared to contemporary CI and clinical imaging and PSA followups. A chart review was performed to document prior imaging, pathology results, serial serum PSA measurements, and other pertinent clinical data. Clinical utility of 18F-DCFPyL PET was measured using a simulated tumor board formed by three physicians with extensive prostate cancer experience deciding on management with and without knowledge of PET/CT results.

Results: At median PSA 2.27 (interquartile rage [IQR] 5.27], 82% of 18F-DCFPyL PET/CT demonstrated at least one site of disease: non-regional lymph nodes (37% of scans), regional lymph node metastases (28%), local recurrence (27%), and bone metastases (20%), with higher PET positivity at higher PSA. Compared to 18F-DCFPyL PET/CT, CI showed overall poor performance, with accuracy below 20% for all extent of disease. PET/CT changed management in 44% of cases. The most frequent scenario was a radical change from initiating androgen deprivation therapy (ADT) to stereotactic body radiotherapy (SBRT) of oligo-lesional disease. In univariate and multivariate analysis, no patient characteristic could predict change of management by PET/CT results.

Conclusions: 18F-DCFPyL significantly outperforms CI in recurring prostate cancer and is likely to impact management.

Published
2020-11-17
How to Cite
Chaussé, G., Ben-Ezra, N., Stoopler, M., Levett, J. Y., Niazi, T., Anidjar, M., Abikhzer, G., & Probst, S. (2020). Diagnostic performance of 18F-DCFPyL positron emission tomography/computed tomography for biochemically recurrent prostate cancer and change-of-management analysis. Canadian Urological Association Journal, 15(6), 173-8. https://doi.org/10.5489/cuaj.6817
Section
Original Research