Prospective study on the value of PSMA-based ¹⁸F-DCFPyL PET/CT scanning in the evaluation of patients with prostate cancer: how does it change the clinical management?

Introduction: Despite the high diagnostic yield and the growing interest in the use of prostate-specific membrane antigen (PSMA)-targeted PET/CT scan, there is an ongoing debate on the role of PSMA-based PET/CT scanning for management of patients with prostate cancer (PCa). This study aimed to investigate the clinical impact of PSMA-based PET/CT scanning in patients with known PCa.

Methods: This IRB-approved, HIPAA-compliant, single-center, prospective study has been conducted since April 2020 in patients with known PCa. The preliminary study cohort comprised 45 patients (mean age: 70, ranging 50-92), including 11 with recently diagnosed PCa, 26 with treated PCa, and 8 on active surveillance. The indications for performing PSMA PET/CT scan were initial staging in 11, and restaging in 34 individuals. Patients underwent PET/CT scan using ¹⁸F-DCFPyL. Pre- and post- PSMA-PET/CT questionnaires were completed by the referring physician within two weeks before and 4 weeks after reviewing the results of the ¹⁸F-DCFPyL PET/CT study.

Results: PSMA PET/CT scan upstaged disease in 23.5% (8/34) of the individuals who were referred for PCa restaging and helped with initial staging in another 11 patients of the study cohort. After reviewing the ¹⁸F-DCFPyL PET/CT results, additional diagnostic procedures were avoided in 24.4% (11/45) of patients, while prostate or bone biopsy was further carried out for 17.8% (8/45) of the study cohort. Overall, the management course was altered in 51.1% (23/45) of the individuals, of whom the treatment plan was changed in 56.5% (13/23). In 62.5% (5/8) of the individuals under active surveillance, curative-intent treatment was considered based on the upstaging by ¹⁸F-DCFPyL PET/CT results. Conclusion: PSMA-based ¹⁸F-DCFPyL PET/CT scanning altered patient management in 51.1% of the study cohort. The preliminary results show that ¹⁸F-DCFPyL PET/CT imaging is an important tool for the initial staging and restaging in patients with PCa.

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