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

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

doi:10.1016/j.ijrobp.2019.11.001

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

Int J Radiat Oncol Biol Phys. 2020 Mar 1;106(3):546-555. doi: 10.1016/j.ijrobp.2019.11.001. Epub 2019 Nov 12.

Authors

Wei Liu¹, Katherine Zukotynski², Louise Emmett³, Hans T Chung⁴, Peter Chung⁵, Robert Wolfson⁶, Irina Rachinsky⁷, Anil Kapoor⁸, Ur Metser⁹, Andrew Loblaw¹⁰, Gerard Morton⁴, Tracy Sexton¹, Michael Lock¹, Joelle Helou⁵, Alejandro Berlin⁵, Colm Boylan¹¹, Susan Archer¹, Gregory R Pond¹², Glenn Bauman¹³

Affiliations

¹ Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada.
² Department of Radiology, Hamilton Health Sciences Centre and McMaster University, Hamilton, Canada.
³ Department of Nuclear Medicine and Theranostics, St. Vincent's Hospital and University of New South Wales, Sydney, Australia.
⁴ Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
⁵ Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.
⁶ Department of Medical Imaging, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada.
⁷ Division of Nuclear Medicine, London Health Sciences Centre and Western University, London, Canada.
⁸ Urologic Cancer Centre for Research & Innovation and McMaster University, Hamilton, Ontario.
⁹ Department of Medical Imaging, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada.
¹⁰ Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; University of Toronto, Institute of Health Care Policy and Evaluation, Toronto, Canada.
¹¹ Department of Diagnostic Imaging, St. Joseph's Healthcare and McMaster University, Hamilton, Canada.
¹² Department of Oncology, McMaster University, Hamilton, Canada.
¹³ Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre and Western University, London, Canada. Electronic address: Glenn.Bauman@lhsc.on.ca.

PMID: 31730876
DOI: 10.1016/j.ijrobp.2019.11.001

Abstract

Purpose: Radio-recurrent prostate cancer is typically detected by a rising prostate-specific antigen and may reflect local or distant disease. Positron emission tomography (PET) radiotracers targeting prostate-specific membrane antigen, such as 18F-DCFPyL have shown promise in restaging men with recurrent disease postprostatectomy but are less well characterized in the setting of radio-recurrent disease.

Methods and materials: A prospective, multi-institutional study was conducted to evaluate the effect of 18F-DCFPyL PET/computed tomography (CT) when added to diagnostic imaging (DI; CT abdomen and pelvis, bone scan, multiparametric magnetic resonance imaging pelvis) for men with radio-recurrent prostate cancer. All men were imaged with DI and subsequently underwent 18F-DCFPyL PET/CT with local and central reads. Tie break reads were performed as required. Management questionnaires were completed after DI and again after 18F-DCFPyL PET/CT. Discordance in patterns of disease detected with 18F-DCFPyL PET/CT versus DI and changes in management were characterized.

Results: Seventy-nine men completed the study. Most men had T1 disease (62%) and Gleason score <7 (95%). Median prostate-specific antigen at diagnosis was 7.4 ng/mL and at relapse was 4.8 ng/mL. DI detected isolated intraprostatic recurrence in 38 out of 79 men (48%), regional nodal recurrence in 9 out of 79 (11%), distant disease in 12 out of 79 (15%), and no disease in 26 out of 79 (33%). 18F-DCFPyL PET/CT detected isolated intraprostatic recurrence in 38 out of 79 men (48%), regional nodal recurrence in 21 out of 79 (27%), distant disease in 24 out of 79 (30%), and no disease in 10 out of 79 (13%). DI identified 8 out of 79 (10%) patients to have oligometastatic disease, compared with 21 out of 79 (27%) with 18F-DCFPyL PET/CT. 18F-DCFPyL PET/CT changed proposed management in 34 out of 79 (43%) patients.

Conclusions: 18F-DCFPyL PET/CT identified extraprostatic disease in twice as many men with radio-recurrent prostate cancer compared with DI and detected a site of recurrence in 87% of men compared with 67% with DI. Furthermore, 18F-DCFPyL PET/CT identified potentially actionable disease (prostate only recurrence or oligometastatic disease) in 75% of men and changed proposed management in 43% of men.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Antigens, Surface / blood
Fluorine Radioisotopes
Glutamate Carboxypeptidase II / blood
Humans
Kallikreins / blood
Lysine / analogs & derivatives*
Male
Middle Aged
Neoplasm Recurrence, Local / blood
Neoplasm Recurrence, Local / diagnostic imaging*
Neoplasm Recurrence, Local / pathology
Neoplasm Recurrence, Local / radiotherapy
Positron Emission Tomography Computed Tomography / methods*
Prospective Studies
Prostate-Specific Antigen / blood
Prostatic Neoplasms / blood
Prostatic Neoplasms / diagnostic imaging*
Prostatic Neoplasms / pathology
Prostatic Neoplasms / radiotherapy
Urea / analogs & derivatives*

Substances

2-(3-(1-carboxy-5-((6-fluoropyridine-3-carbonyl)amino)pentyl)ureido)pentanedioic acid
Antigens, Surface
Fluorine Radioisotopes
Urea
FOLH1 protein, human
Glutamate Carboxypeptidase II
KLK3 protein, human
Kallikreins
Prostate-Specific Antigen
Lysine