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Prospective Evaluation of 18F-DCFPyL PET/CT in Detection of High-Risk Localized Prostate Cancer: Comparison With mpMRI

  1. Author:
    Gaur, Sonia
    Mena, Esther
    Harmon,Stephanie
    Lindenberg, Maria L
    Adler,Stephen
    Ton, Anita T
    Shih, Joanna H
    Mehralivand, Sherif
    Merino, Maria J
    Wood, Bradford J
    Pinto, Peter A
    Mease, Ronnie C
    Pomper, Martin G
    Choyke, Peter L
    Turkbey, Baris

  2. Author Address

    Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, Rm B3B85, Bethesda, MD 20814., Department of Radiology, Michigan Medicine, Ann Arbor, MI., Clinical Research Directorate, Leidos Biomedical Research, Inc., National Cancer Institute Campus at Frederick, Frederick, MD., Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, MD., Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD., Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD., Center for Interventional Oncology, Clinical Center, National Institutes of Health, Bethesda, MD., Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD.,
    1. Year: 2020
    2. Date: Jul 08
    3. Epub Date: 2020 07 08
  2. Journal: AJR. American journal of roentgenology
    1. Pages: 1-8
  4. Type of Article: Article
  1. Abstract:

    OBJECTIVE. The purpose of this study was to assess utility of PET with (2S)-2-[[(1S)-1-carboxy-5-[(6-(18F)fluoranylpyridine-3-carbonyl)amino]pentyl]carbamoylamino]pentanedioic acid (18F-DCFPyL), a prostate-specific membrane antigen (PSMA)-targeted radiotracer, in the detection of high-risk localized prostate cancer as compared with multiparametric MRI (mpMRI). SUBJECTS AND METHODS. This HIPAA-compliant prospective study included 26 consecutive patients with localized high-risk prostate cancer (median age, 69.5 years [range, 53-81 years]; median prostate-specific antigen [PSA] level, 18.88 ng/mL [range, 1.03-20.00 ng/mL]) imaged with 18F-DCFPyL PET/CT and mpMRI. Images from PET/CT and mpMRI were evaluated separately, and suspicious areas underwent targeted biopsy. Lesion-based sensitivity and tumor detection rate were compared for PSMA PET and mpMRI. Standardized uptake value (SUV) and PSMA PET parameters were correlated with histopathology score, and uptake in tumor was compared with that in nonmalignant tissue. On a patient level, SUV and PSMA tumor volume were correlated with PSA density. RESULTS. Forty-four tumors (one in Gleason grade [GG] group 1, 12 in GG group 2, seven in GG group 3, nine in GG group 4, and 15 in GG group 5) were identified at histopathology. Sensitivity and tumor detection rate of 18F-DCFPyL PET/CT and mpMRI were similar (PET/CT, 90.9% and 80%; mpMRI, 86.4% and 88.4%; p = 0.58/0.17). Total lesion PSMA and PSMA tumor volume showed a relationship with GG (t = 0.27 and p = 0.08, t = 0.30 and p = 0.06, respectively). Maximum SUV (SUVmax) in tumor was significantly higher than that in nonmalignant tissue (p < 0.05). Tumor burden density moderately correlated with PSA density (r = 0.47, p = 0.01). Five true-positive tumors identified on 18F-DCFPyL PET/CT were not identified on mpMRI. CONCLUSION. In patients with high-risk prostate cancer, 18F-DCFPyL PET/CT is highly sensitive in detecting intraprostatic tumors and can detect tumors missed on mpMRI. Measured uptake is significantly higher in tumor tissue, and PSMA-derived tumor burden is associated with severity of disease.

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  2. DOI: 10.2214/AJR.19.22042
  3. PMID: 32755168

Library Notes

  1. Fiscal Year: FY2019-2020
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