A Prospective Study on 18F-DCFPyL PSMA PET/CT Imaging in Biochemical Recurrence of Prostate Cancer.

18F-DCFPyL, a prostate specific membrane antigen targeting radiotracer, has shown promise as a prostate cancer imaging radiotracer. We evaluated the safety, sensitivity and impact on patient management of 18F-DCFPyL in the settings of biochemical recurrence of prostate cancer.

Subjects with prostate cancer and biochemical recurrence post radical prostatectomy/curative intent radiotherapy were included in this prospective study. The subjects underwent 18F-DCFPyL PET/CT imaging. The localisation and number of lesions were recorded. The uptake characteristics of the five most active lesions were measured. A pre- and post-test questionnaire was sent to treating physicians to assess the impact on management.

One-hundred and thirty subjects were evaluated. 18F-DCFPyL PET/CT localized recurrent prostate cancer in 60% (PSA ≥0.4 to <0.5), 78% (≥0.5 to <1.0), 72% (≥1.0 to <2.0), and 92% (≥2.0) of cases. Many subjects had few lesions: one lesion (40.8%), two (8.5%), three (4.6%). The number of lesions was significantly related to PSA by ANOVA analysis, but there was a large overlap in the PSA values for number of lesions categories. Total lesion uptake was also significantly related to PSA values. Change in treatment intent occurred in 65.5% of subjects. Disease stage changed in 65.5%. Management plans changed in 87.3% of subjects. Twenty-two subjects reported mild adverse events after the scan; all resolved completely.

18F-DCFPyL PET/CT is safe and sensitive for the localization of biochemical recurrence of prostate cancer. This test improved decision making for referring oncologists and changed management for the majority of subjects.

Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2019 Apr 12 [Epub ahead of print]

Etienne Rousseau, Don Wilson, Frédéric Lacroix-Poisson, Andra Krauze, Kim Chi, Martin Gleave, Michael McKenzie, Scott Tyldesley, S Larry Goldenberg, François Bénard

BC Cancer, Canada., University of British Columbia, Canada.

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