Diagnostic and therapeutic impact of PET/CT with 18F-DCFPyL versus 18F-Fluorocholine in initial staging of intermediate-/high-risk prostate cancer: a pilot study

Cristina Lucas Lucas; Laura García Zoghby; Mariano Amo-Salas; Ángel María Soriano Castrejón; Ana María García Vicente

doi:10.1007/s12149-023-01859-4

Diagnostic and therapeutic impact of PET/CT with 18F-DCFPyL versus 18F-Fluorocholine in initial staging of intermediate-/high-risk prostate cancer: a pilot study

Ann Nucl Med. 2023 Oct;37(10):551-560. doi: 10.1007/s12149-023-01859-4. Epub 2023 Aug 2.

Authors

Cristina Lucas Lucas¹, Laura García Zoghby², Mariano Amo-Salas³, Ángel María Soriano Castrejón², Ana María García Vicente⁴

Affiliations

¹ Nuclear Medicine Department, University General Hospital, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain.
² Nuclear Medicine Department, Complejo Hospitalario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain.
³ Department of Mathematics, Castilla-La Mancha University, Ciudad Real, Spain.
⁴ Nuclear Medicine Department, Complejo Hospitalario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain. angarvice@yahoo.es.

PMID: 37532975
DOI: 10.1007/s12149-023-01859-4

Abstract

Aim: To assess the diagnostic and therapeutic impact of PET/CT with 18F-DCFPyL with respect to 18F-Fluorocholine in initial staging of intermediate-/high-risk prostate cancer (PCa).

Material and methods: Patients with recent diagnosis of intermediate-/high-risk PCa without androgen deprivation therapy and previous 18F-Fluorocholine-PET/CT (negative for extraprostatic disease or with oligometastatic disease) were referred to 18F-DCFPyL-PET/CT. Patients' disease characteristic as grade group, D'Amico risk category (intermediate/high), prostate-specific antigen (PSA) closest to PET/CTs and its kinetics were obtained. The overall detection rate (DR) and molecular imaging TNM (miTNM) stage according to the prostate cancer molecular imaging standardized evaluation (PROMISE) criteria were assessed for both radiotracers, and their concordance (Kappa coefficient) was analyzed. The diagnostic and therapeutic impact of 18F-DCFPyL with respect to 18F-Fluorocholine was evaluated.

Results: Fifty-eight patients were analyzed (84.5% high-risk). 18F-Fluorocholine showed a higher DR than 18F-DCFPyL of prostate gland involvement (100% versus 93.1%) and pelvic node disease (37.9% versus 31%; k = 0.436, p = 0.001). On the other hand, 18F-DCFPyL-PET/CT showed a higher DR of metastatic disease than 18F-Fluorocholine-PET/CT, 9/58 patients (15.5%): 3 M1a, 5 M1b and 1 M1c) versus 5/58 (8.6%) patients: 1 M1a and 4 M1b), k = 0.426; p = 0.001. No significant association was found between clinical characteristics (grade group, risk category, PSA level and kinetic) and 18F-Fluorocholine or 18F-DCFPyL results. The results of 18F-DCFPyL-PET/CT modified the previously planned treatment compared to 18F-Fluorocholine-PET/CT in 13 patients (22.4%).

Conclusions: 18F-Fluorocholine and 18F-DCFPyL PET/CT showed a similar DR of prostate gland and lymph node involvement, although with moderate concordance for the latter. 18F-DCFPyL was superior to 18F-Fluorocholine in detecting regional and distant metastasis with a therapeutic impact in one of every five patients.

Keywords: 18F-DCFPyL PET/CT; 18F-Fluorocholine PET/CT; Initial staging; PSMA PET/CT; Prostate cancer; Therapeutic impact.

MeSH terms

Androgen Antagonists
Humans
Male
Pilot Projects
Positron Emission Tomography Computed Tomography* / methods
Prostate-Specific Antigen
Prostatic Neoplasms* / diagnostic imaging
Prostatic Neoplasms* / pathology
Prostatic Neoplasms* / therapy

Substances

Prostate-Specific Antigen
fluorocholine
Androgen Antagonists
fluoromethylcholine
2-(3-(1-carboxy-5-((6-fluoropyridine-3-carbonyl)amino)pentyl)ureido)pentanedioic acid