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

Abstract

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. Methods: 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. Results: 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. Conclusion: 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.