A Prospective Study of 18F-DCFPyL PSMA PET/CT Restaging in Recurrent Prostate Cancer following Primary External Beam Radiotherapy or Brachytherapy

Liu, Wei; Zukotynski, Katherine; Emmett, Louise; Chung, Hans T.; Chung, Peter; Wolfson, Robert J.; Rachinsky, Irina; Kapoor, Anil; Metser, Ur; Loblaw, Andrew; Morton, Gerard; Sexton, Tracy; Lock, Michael; Helou, Joelle; Berlín, Alejandro; Boylan, Colm; Archer, Susan; Pond, Gregory R.

doi:10.1016/j.ijrobp.2019.11.001

Cited by 47 publications

(31 citation statements)

References 63 publications

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“…Actual management and proposed management changes were compared in a prospective, multicenter study ( NCT02793284 ) 7 of 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid ( 18 F-DCFPyL) PSMA-targeted PET/CT in men with recurrent prostate cancer after radiation therapy. Eligibility criteria included localized T1-2 prostate cancer at initial staging with zero or 1 high-risk feature (prostate-specific antigen [PSA] >20 or Gleason score 8); treatment with primary radiation therapy, with or without androgen deprivation therapy (ADT); and biochemical failure according to Phoenix criteria.…”

Section: Methodsmentioning

confidence: 99%

“…The primary endpoint of the study was the proportion of patients with extraprostatic lesions as detected by CI versus PET/CT and has been reported. 7 Secondary endpoints included changes in management. Changes in whether men underwent systemic therapy, directed salvage, or combinations were considered major changes and are the basis of this report.…”

Section: Methodsmentioning

confidence: 99%

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Utilization of Salvage and Systemic Therapies for Recurrent Prostate Cancer as a Result of 18F-DCFPyL PET/CT Restaging

Liu

Zukotynski

Emmett

et al. 2021

Advances in Radiation Oncology

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Purpose Our purpose was to investigate the effect of the addition of prostate-specific membrane antigen (PSMA)-targeted positron emission tomography/computed tomography (PET/CT) in patients with recurrent prostate cancer post-primary radiation therapy. Methods and Materials A prospective, multi-institutional clinical trial evaluated 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid ( 18 F-DCFPyL) PET/CT restaging in 79 men with recurrent prostate cancer post-primary radiation therapy. We report actual patient management and compare this with proposed management both before and after PSMA-targeted PET/CT. Results Most patients (59%) had a major change in actual management compared with pre-PET/CT proposed management. The rate of major change was underestimated by immediately post-PET/CT surveys (32%). Eighteen patients with PSMA avidity in the prostate gland suspicious for malignancy had a prostate biopsy. Sensitivity, specificity, and positive predictive values of PSMA uptake in the prostate were 86%, 67%, and 92%, respectively. Thirty percent of patients had directed salvage therapy and 41% underwent systemic therapy. Eleven out of 79 patients (14%) had high-dose-rate brachytherapy alone for local recurrence, and 91% were free of recurrence at a median follow-up of 20 months. Conclusions Most patients had a major change in actual management compared with pre–PSMA-targeted PET/CT planned management, and this was underestimated by post-PET/CT questionnaires.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Utilization of Salvage and Systemic Therapies for Recurrent Prostate Cancer as a Result of 18F-DCFPyL PET/CT Restaging

Liu

Zukotynski

Emmett

et al. 2021

Advances in Radiation Oncology

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“…18 F-DCFPyL PET detected intraprostatic recurrence in 87% of men compared with 67% with MRI. However, this study included multiple types of radiation therapy including EBRT and brachytherapy; moreover there was no histopathologic validation for the intraprostatic foci suspicious for recurrence (25).…”

Section: Discussionmentioning

confidence: 99%

Multiparametric MRI and 18F-DCFPyL PET/CT for Detection of Locally Recurrent Prostate Cancer After Low dose Rate Brachytherapy

Walker¹,

Fernandez²,

Roy³

et al. 2020

Preprint

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Background and purpose: Both multiparametric magnetic resonance imaging (mpMRI) and prostate specific membrane antigen (PSMA)-targeting positron emission tomography (PET) imaging have shown promise in early localization of prostate cancer (PCa) recurrence after primary external beam radiotherapy. Detecting recurrence after brachytherapy for PCa using MRI is significantly hampered by susceptibility artifacts secondary to brachy seeds. Here, we compare the efficacy of 18F-DCFPyL (2-(3-{1-carboxy-5-[(6-18F-fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid) PET/CT versus mpMRI for detecting sites of local recurrence after low dose rate (LDR) brachytherapy for prostate cancer. Materials and methods: A total of 155 patients with a history of recurrent PCa who underwent mpMRI at 3 Tesla and 18F-DCFPyL PET/CT were retrospectively reviewed. Patients who underwent LDR brachytherapy for PCa and had subsequent biochemical recurrence (BCR) followed by mpMRI and 18F-DCFPyL PET/CT were included in this study. mpMRI was performed on a 3T scanner with endorectal and surface coils and images were prospectively read by a single expert radiologist. The 18F-DCFPyL PET/CT scan was prospectively interpreted by one of two nuclear medicine physicians. Patients underwent targeted biopsy when deemed clinically necessary and specimens were interpreted by an expert GU pathologist. Positivity rates (PR) from mpMRI and 18F-DCFPyL PET/CT were compared, and pathology results were used to calculate the positive predictive value (PPV) of each imaging modality for detecting PCa recurrence.Results: 14 patients who underwent LDR brachytherapy and had subsequent biochemical failure were imaged with mpMRI and 18F-DCFPyL PET/CT. 17 lesions were identified on at least one imaging modality. The PR for detection of intraprostatic lesions was 71% (10/14) for PET/CT and 64.3% (9/14) for mpMRI. 18F-DCFPyL PET/CT identified pelvic and extra-pelvic lymph nodes in 8 (57%) patients, while mpMRI noted positive lymph node findings in only 2 (14%) patients. A total of 14 lesions corresponding to 8 patients were targeted for biopsy and in these, 18F-DCFPyL PET/CT performed better than mpMRI for the detection of local recurrence with a PPV of 81.8% vs. 66.7%. For the detection of intraprostatic lesions, 18F-DCFPyL PET/CT and mpMRI had a PPV of 87.5% and 71.4%, respectively. Conclusion: Our findings suggest that 18F-DCFPyL PET/CT detects local and regional recurrent PCa after LDR brachytherapy at a higher rate than mpMRI and has a much higher detection rate of suspicious pelvic lymph nodes. Further studies are needed to validate these findings in larger cohorts.

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Section: Discussionmentioning

confidence: 99%

Multiparametric MRI and 18F-DCFPyL PET/CT for detection of locally recurrent prostate cancer after low dose rate brachytherapy

Walker¹,

Fernández²,

Roy³

et al. 2020

Preprint

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Background and purpose: Both multiparametric magnetic resonance imaging (mpMRI) and prostate specific membrane antigen (PSMA)-targeting positron emission tomography (PET) imaging have shown promise in early localization of prostate cancer (PCa) recurrence after primary external beam radiotherapy. Detecting recurrence after brachytherapy for PCa using MRI is significantly hampered by susceptibility artifacts secondary to brachy seeds. Here, we compare the efficacy of 18F-DCFPyL (2-(3-{1-carboxy-5-[(6-18F-fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid) PET/CT versus mpMRI for detecting sites of local recurrence after low dose rate (LDR) brachytherapy for prostate cancer.Materials and methods: A total of 155 patients with a history of recurrent PCa who underwent mpMRI at 3 Tesla and 18F-DCFPyL PET/CT were retrospectively reviewed. Patients who underwent LDR brachytherapy for PCa and had subsequent biochemical recurrence (BCR) followed by mpMRI and 18F-DCFPyL PET/CT were included in this study. mpMRI was performed on a 3T scanner with endorectal and surface coils and images were prospectively read by a single expert radiologist. The 18F-DCFPyL PET/CT scan was prospectively interpreted by one of two nuclear medicine physicians. Patients underwent targeted biopsy when deemed clinically necessary and specimens were interpreted by an expert GU pathologist. Positivity rates (PR) from mpMRI and 18F-DCFPyL PET/CT were compared, and pathology results were used to calculate the positive predictive value (PPV) of each imaging modality for detecting PCa recurrence.Results: 15 patients who underwent LDR brachytherapy and had subsequent biochemical failure were imaged with mpMRI and 18F-DCFPyL PET/CT. 18 non-lymph node lesions were identified on at least one imaging modality. The PR for detection of intraprostatic lesions was 60% (9/15) for both PET/CT and mpMRI, with 3 prostate lesions detected by only one modality. 18F-DCFPyL PET/CT identified pelvic and extra-pelvic lymph nodes in 8 (53%) patients, while mpMRI noted positive lymph node findings in only 2 (13%) patients. A total of 15 lesions corresponding to 9 patients were targeted for biopsy. The PPV of 18F-DCFPyL PET/CT and mpMRI for the detection of local recurrence were 84.6% and 71.4%, respectively. For the detection of intraprostatic lesions, 18F-DCFPyL PET/CT and mpMRI had a PPV of 87.5% and 71.4%, respectively. Conclusion: This case series analysis suggests that 18F-DCFPyL PET/CT may detect local and regional recurrent PCa after LDR brachytherapy at a higher rate than mpMRI and that it has the potential to detect suspicious pelvic lymph nodes at a much higher rate. Further studies are needed to validate these findings in larger cohorts.

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A Prospective Study of 18F-DCFPyL PSMA PET/CT Restaging in Recurrent Prostate Cancer following Primary External Beam Radiotherapy or Brachytherapy

Cited by 47 publications

References 63 publications

Utilization of Salvage and Systemic Therapies for Recurrent Prostate Cancer as a Result of 18F-DCFPyL PET/CT Restaging

Utilization of Salvage and Systemic Therapies for Recurrent Prostate Cancer as a Result of 18F-DCFPyL PET/CT Restaging

Multiparametric MRI and 18F-DCFPyL PET/CT for Detection of Locally Recurrent Prostate Cancer After Low dose Rate Brachytherapy

Multiparametric MRI and 18F-DCFPyL PET/CT for detection of locally recurrent prostate cancer after low dose rate brachytherapy

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