Our objective was to investigate the factors predicting scan positivity and disease location in patients with biochemical recurrence (BCR) of prostate cancer (PCa) after primary local therapy using prostate-specific membrane antigen-targeted 18F-DCFPyL PET/CT. Methods: This was a 2-institution study including 245 BCR PCa patients after primary local therapy and negative results on conventional imaging. The patients underwent 18F-DCFPyL PET/CT. We tested for correlations of lesion detection rate and disease location with tumor characteristics, time from initial therapy, prostate-specific antigen (PSA) level, and PSA doubling time (PSAdt). Multivariate logistic regression analyses were used to determine predictors of a positive scan. Regression-based coefficients were used to develop nomograms predicting scan positivity and extrapelvic disease. Results: Overall, 79.2% (194/245) of patients had a positive 18F-DCFPyL PET/CT result, with detection rates of 48.2% (27/56), 74.3% (26/35), 84% (37/44), 96.7% (59/61), and 91.8% (45/49) for PSAs of <0.5, 0.5 to <1.0, 1.0 to <2.0, 2.0 to <5.0, and ≥5.0 ng/mL, respectively. Patients with lesions confined to the pelvis had lower PSAs than those with distant sites (1.6 ± 3.5 vs. 3.0 ± 6.3 ng/mL, P < 0.001). In patients treated with prostatectomy (n = 195), 24.1% (47/195) had a negative scan result, 46.1% (90/195) showed intrapelvic disease, and 29.7% (58/195) showed extrapelvic disease. In the postradiation subgroup (n = 50), 18F-DCFPyL PET/CT was always negative at a PSA lower than 1.0 ng/mL and extrapelvic disease was seen only when PSA was greater than 2.0 ng/mL. At multivariate analysis, PSA and PSAdt were independent predictive factors of scan positivity and the presence of extrapelvic disease in postsurgical patients, with area under the curve of 78% and 76%, respectively. PSA and PSAdt were independent predictors of the presence of extrapelvic disease in the postradiation cohort, with area under the curve of 85%. Time from treatment to scan was significantly longer for prostatectomy-bed-only recurrences than for those with bone or visceral disease (6.2 ± 6.4 vs. 2.4 ± 1.3 y, P < 0.001). Conclusion:18F-DCFPyL PET/CT offers high detection rates in BCR PCa patients. PSA and PSAdt are able to predict scan positivity and disease location. Furthermore, the presence of bone or visceral lesions is associated with shorter intervals from treatment than are prostate-bed-only recurrences. These tools might guide clinicians to select the most suitable candidates for 18F-DCFPyL PET/CT imaging.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2021 Dec 16 [Epub]
Esther Mena, Steven P Rowe, Joanna H Shih, Liza Lindenberg, Baris Turkbey, Aloyse Fourquet, Frank I Lin, Stephen Adler, Philip Eclarinal, Yolanda L McKinney, Deborah E Citrin, William Dahut, Bradford J Wood, Richard Chang, Elliot Levy, Maria Merino, Michael A Gorin, Martin G Pomper, Peter A Pinto, Janet F Eary, Peter L Choyke, Kenneth J Pienta
Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; ., Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland., Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland., Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland., Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland., Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland., Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland., Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland., Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland., James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; and., Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.