PT  - JOURNAL ARTICLE
AU  - Cengiz, Turgut Bora
AU  - Novello, Matteo
AU  - Ghesani, Munir
AU  - Gavane, Somali
TI  - <strong>Initial Experience with F18-DCFPyL PET/CT for Metastatic or Biochemically Recurrent Prostate Cancer: A Single Institution Review</strong>
DP  - 2022 Aug 01
TA  - Journal of Nuclear Medicine
PG  - 3077--3077
VI  - 63
IP  - supplement 2
4099  - http://jnm.snmjournals.org/content/63/supplement_2/3077.short
4100  - http://jnm.snmjournals.org/content/63/supplement_2/3077.full
SO  - J Nucl Med2022 Aug 01; 63
AB  - 3077 Introduction: The staging of prostate cancer (PCa) has evolved significantly within the past decade with implementation of multiple prostate-specific imaging modalities. Of those, the first prostate specific membrane antigen positron emission tomography-computed tomography (PSMA PET/CT) imaging agent was approved by the FDA in 2020, and subsequently acknowledged in the National Comprehensive Cancer Network (NCCN®) guidelines. However, there is a paucity of data in the literature to guide the physicians as to how to integrate PSMA PET/CT into clinical practice and patient management. In this study, we aim to describe our early tertiary referral center experience with flourine-18 piflufolastat (F18-DCFPyL) PSMA PET/CT and its impact in diagnosis and change in management plan in metastatic or biochemically recurrent PCa patients.Methods: All patients who underwent flourine-18 piflufolastat (F18-DCFPyL) PET/CTs for suspected metastasis or recurrent PCa between June 2021 and December 2021 were queried. Patient demographics, disease characteristics (e.g., Gleason score [GS], prior prostatectomy, prior radiotherapy) and imaging findings were investigated. The findings seen on PSMA PET/CT were described as no metastasis, local recurrence (in the prostate after primary radiotherapy or prostatectomy), oligometastatic disease (less than 5 metastatic lesions) or metastatic disease (more than 5 metastatic lesions). The locations of the metastases were grouped as pelvic lymph nodes, retroperitoneal or other lymph nodes, bones, and visceral organs. Changes in patient management were assessed via chart review.Results: A total of 83 patients were identified. The mean age was 70 ±8 years. The median prostate specific antigen (PSA) at initial diagnosis was 8.3 ng/mL. Three patients had GS of 6, 31 patients had GS of 7, 8 patients had GS of 8, 17 patients had GS of 9 and one patient had GS of 10. Forty-four patients underwent prostatectomies with or without pelvic lymph node dissection and 15 patients received salvage radiotherapy. Most of the remaining patients were treated with external beam radiation, brachytherapy and/or chemotherapy. The median time until PSMA PET/CT from initial biopsy was 36 months, and the time interval from the prostatectomy date to PSMA PET/CT was 4.9 years.Of those 83 patients who had undergone PSMA PET/CTs, 10 patients (11.6%) were found to have no evidence of recurrence or metastatic disease. These patients had mean PSA level of 0.37 ng/mL. Eleven patients (13.2%) had isolated local recurrence in the prostate gland with mean PSA of 7.2 ng/mL. Twenty-eight patients (33.7%) had oligometastatic disease with mean PSA of 6.1 ng/mL and 33 patients (39.7%) were found to have metastatic disease with mean PSA of 596 ng/mL. Only 4 patients had recurrence in the prostatectomy bed, and all of them had additional pelvic lymph node metastasis. PSMA-avid pelvic lymph nodes were seen in 32 patients (38.5%), and 28 patients (33.7%) had retroperitoneal or other lymph nodal uptake (20 patients [24%] with both pelvic and other lymph nodal uptake). Thirty-six patients (43.3%) were found to have bone metastases with mean PSA of 560 ng/mL. Sixteen patients (19.2%) had visceral metastases (7 with pulmonary, 8 with hepatic [3 with both pulmonary and hepatic] and 4 with other metastases) with mean PSA of 989 ng/mL. Imaging findings are summarized in Table 1.Fourteen patients (14.8%) were referred to Lu177-PSMA 617 treatment under the expanded access program granted to our institution. Almost half of these patients had changes in their management (40 patients [48.1%]) after undergoing PSMA PET/CT.Conclusions: Our initial experience with F18-DCFPyL PSMA PET/CT suggests significant impact on patient management in several cases. Despite the heterogeneity in treatment modalities applied to PCa patients prior to PSMA PET/CT, the diagnostic accuracy of the PSMA PET/CT shows correlation with PSA levels. Additional follow-up data is also being reviewed and validation studies are needed.