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Patterns of disease detection using [18F]DCFPyL PET/CT imaging in patients with detectable PSA post prostatectomy being considered for salvage radiotherapy: a prospective trial

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Abstract

Purpose

Prostate-specific membrane antigen (PSMA) PET/CT is increasingly used in patients with biochemical recurrence post prostatectomy to detect local recurrence and metastatic disease at low PSA levels. The aim of this study was to assess patterns of disease detection, predictive factors and safety using [18F]DCFPyL PET/CT versus diagnostic CT in patients being considered for salvage radiotherapy with biochemical recurrence post prostatectomy.

Methods

We conducted a prospective trial recruiting 100 patients with detectable PSA post prostatectomy (PSA 0.2–2.0 ng/mL) and referred for salvage radiotherapy from August 2018 to July 2020. All patients underwent a PSMA PET/CT using the [18F]DCFPyL tracer and a diagnostic CT. The detection rates of [18F]DCFPyL PET/CT vs diagnostic CT were compared and patterns of disease are reported. Clinical patient and tumour characteristics were analysed for predictive utility. Thirty-day post-scan safety is reported.

Results

Of 100 patients recruited, 98 were suitable for analysis with a median PSA of 0.32 ng/mL. [18F]DCFPyL PET/CT was positive 46.4% and equivocal 5.2%, compared to 15.5% positivity for diagnostic CT. Local recurrence was detected on [18F]DCFPyL PET/CT in 28.5%, nodal disease in 27.5% and bony metastases in 6.1% of patients. Both ISUP grade group (p < 0.001) and pre-scan PSA (p = 0.029) were significant predictors of [18F]DCFPyL PET/CT positivity, and logistic regression generated probabilities combining the two showed improved prediction rates. No significant safety events were reported post [18F]DCFPyL administration.

Conclusions

[18F]DCFPyL PET/CT increases detection of disease in patients with biochemical recurrence post prostatectomy compared to diagnostic CT. Patients being considered for salvage radiotherapy with a PSA >0.2 ng/mL should be considered for [18F]DCFPyL PET/CT scan.

Trial registration

Australian New Zealand Clinical Trials Registry Number: ACTRN12618001530213 (http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375932&isReview=true)

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References

  1. Thompson IM, Valicenti RK, Albertsen P, Davis BJ, Goldenberg SL, Hahn C, et al. Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO guideline. J Urol. 2013;190:441–9. https://doi.org/10.1016/j.juro.2013.05.032.

    Article  PubMed  Google Scholar 

  2. Tendulkar RD, Agrawal S, Gao T, Efstathiou JA, Pisansky TM, Michalski JM, et al. Contemporary update of a multi-institutional predictive nomogram for salvage radiotherapy after radical prostatectomy. J Clin Oncol. 2016;34:3648–54. https://doi.org/10.1200/jco.2016.67.9647.

    Article  PubMed  Google Scholar 

  3. Vargas HA, Martin-Malburet AG, Takeda T, Corradi RB, Eastham J, Wibmer A, et al. Localizing sites of disease in patients with rising serum prostate-specific antigen up to 1ng/ml following prostatectomy: How much information can conventional imaging provide? Urol Oncol. 2016;34:482 e5–e10. https://doi.org/10.1016/j.urolonc.2016.05.026.

    Article  Google Scholar 

  4. Ananias HJ, van den Heuvel MC, Helfrich W, de Jong IJ. Expression of the gastrin-releasing peptide receptor, the prostate stem cell antigen and the prostate-specific membrane antigen in lymph node and bone metastases of prostate cancer. Prostate. 2009;69:1101–8. https://doi.org/10.1002/pros.20957.

    Article  PubMed  Google Scholar 

  5. Minner S, Wittmer C, Graefen M, Salomon G, Steuber T, Haese A, et al. High level PSMA expression is associated with early PSA recurrence in surgically treated prostate cancer. Prostate. 2011;71:281–8. https://doi.org/10.1002/pros.21241.

    Article  PubMed  Google Scholar 

  6. Perera M, Papa N, Roberts M, Williams M, Udovicich C, Vela I, et al. Gallium-68 prostate-specific membrane antigen positron emission tomography in advanced prostate cancer-updated diagnostic utility, sensitivity, specificity, and distribution of prostate-specific membrane antigen-avid lesions: a systematic review and meta-analysis. Eur Urol. 2020;77:403–17. https://doi.org/10.1016/j.eururo.2019.01.049.

    Article  PubMed  Google Scholar 

  7. Dietlein F, Kobe C, Neubauer S, Schmidt M, Stockter S, Fischer T, et al. PSA-stratified performance of 18F- and 68Ga-PSMA PET in patients with biochemical recurrence of prostate cancer. J Nucl Med. 2017;58:947–52. https://doi.org/10.2967/jnumed.116.185538.

    Article  CAS  PubMed  Google Scholar 

  8. Lindenberg L, Mena E, Turkbey B, Shih JH, Reese SE, Harmon SA, et al. Evaluating biochemically recurrent prostate cancer: histologic validation of (18)F-DCFPyL PET/CT with comparison to multiparametric MRI. Radiology. 2020;296:564–72. https://doi.org/10.1148/radiol.2020192018.

    Article  PubMed  Google Scholar 

  9. Hofman MS, Iravani A, Nzenza T, Murphy DG. Advances in urologic imaging: prostate-specific membrane antigen ligand PET imaging. Urol Clin N Am. 2018;45:503–24. https://doi.org/10.1016/j.ucl.2018.03.016.

    Article  Google Scholar 

  10. Rowe SP, Gorin MA, Pomper MG. Imaging of prostate-specific membrane antigen using [(18)F]DCFPyL. PET Clin. 2017;12:289–96. https://doi.org/10.1016/j.cpet.2017.02.006.

    Article  PubMed  Google Scholar 

  11. Perry E, Talwar A, Taubman K, Ng M, Wong LM, Booth R, et al. [(18)F]DCFPyL PET/CT in detection and localization of recurrent prostate cancer following prostatectomy including low PSA < 0.5 ng/mL. Eur J Nucl Med Mol Imaging. 2021. https://doi.org/10.1007/s00259-020-05143-9.

  12. IBM Corp. IBM SPSS statistics for windows, version 26.0. Armonk: IBM Corp; 2019.

    Google Scholar 

  13. R Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for statistical Computing; 2020.

  14. Sing T, Sander O, Beerenwinkel N, Lengauer T. ROCR: visualizing classifier performance in R. Bioinformatics. 2005;21:78–81.

    Article  Google Scholar 

  15. Robin X, Turck N, Hainard A, Tiberti N, Lisacek F, Sanchez J-C, et al. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics. 2011;12:77.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Perera M, Papa N, Roberts M, Williams M, Udovicich C, Vela I, et al. Gallium-68 prostate-specific membrane antigen positron emission tomography in advanced prostate cancer-updated diagnostic utility, sensitivity, specificity, and distribution of prostate-specific membrane antigen-avid lesions: a systematic review and meta-analysis. Eur Urol. 2019. https://doi.org/10.1016/j.eururo.2019.01.049.

  17. Liu W, Zukotynski K, Emmett L, Chung HT, Chung P, Wolfson R, et al. A prospective study of 18F-DCFPyL PSMA PET/CT restaging in recurrent prostate cancer following primary external beam radiotherapy or brachytherapy. Int J Radiat Oncol Biol Phys. 2020;106:546–55. https://doi.org/10.1016/j.ijrobp.2019.11.001.

    Article  CAS  PubMed  Google Scholar 

  18. Jansen BHE, Jansen RW, Wondergem M, Srbljin S, de Klerk JMH, Lissenberg-Witte BI, et al. Lesion detection and interobserver agreement with advanced image reconstruction for (18)F-DCFPyL PET/CT in patients with biochemically recurrent prostate cancer. J Nucl Med. 2020;61:210–6. https://doi.org/10.2967/jnumed.118.222513.

    Article  CAS  PubMed  Google Scholar 

  19. Wondergem M, Jansen BHE, van der Zant FM, van der Sluis TM, Knol RJJ, van Kalmthout LWM, et al. Early lesion detection with (18)F-DCFPyL PET/CT in 248 patients with biochemically recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2019;46:1911–8. https://doi.org/10.1007/s00259-019-04385-6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Rowe SP, Campbell SP, Mana-Ay M, Szabo Z, Allaf ME, Pienta KJ, et al. Prospective evaluation of PSMA-targeted (18)F-DCFPyL PET/CT in men with biochemical failure after radical prostatectomy for prostate cancer. J Nucl Med. 2020;61:58–61. https://doi.org/10.2967/jnumed.119.226514.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Rousseau E, Wilson D, Lacroix-Poisson F, Krauze A, Chi K, Gleave M, et al. A prospective study on (18)F-DCFPyL PSMA PET/CT imaging in biochemical recurrence of prostate cancer. J Nucl Med. 2019;60:1587–93. https://doi.org/10.2967/jnumed.119.226381.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Song H, Harrison C, Duan H, Guja K, Hatami N, Franc BL, et al. Prospective evaluation of (18)F-DCFPyL PET/CT in biochemically recurrent prostate cancer in an academic center: a focus on disease localization and changes in management. J Nucl Med. 2020;61:546–51. https://doi.org/10.2967/jnumed.119.231654.

    Article  CAS  PubMed  Google Scholar 

  23. Emmett L, Tang R, Nandurkar R, Hruby G, Roach P, Watts JA, et al. 3-year freedom from progression after (68)Ga-PSMA PET/CT-triaged management in men with biochemical recurrence after radical prostatectomy: results of a prospective multicenter trial. J Nucl Med. 2020;61:866–72. https://doi.org/10.2967/jnumed.119.235028.

    Article  CAS  PubMed  Google Scholar 

  24. Dietlein M, Kobe C, Kuhnert G, Stockter S, Fischer T, Schomacker K, et al. Comparison of [(18)F]DCFPyL and [ (68)Ga]Ga-PSMA-HBED-CC for PSMA-PET imaging in patients with relapsed prostate cancer. Mol Imaging Biol. 2015;17:575–84. https://doi.org/10.1007/s11307-015-0866-0.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Eiber M, Kroenke M, Wurzer A, Ulbrich L, Jooss L, Maurer T, et al. (18)F-rhPSMA-7 PET for the detection of biochemical recurrence of prostate cancer after radical prostatectomy. J Nucl Med. 2020;61:696–701. https://doi.org/10.2967/jnumed.119.234914.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Giesel FL, Knorr K, Spohn F, Will L, Maurer T, Flechsig P, et al. Detection efficacy of (18)F-PSMA-1007 PET/CT in 251 patients with biochemical recurrence of prostate cancer after radical prostatectomy. J Nucl Med. 2019;60:362–8. https://doi.org/10.2967/jnumed.118.212233.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Boreta L, Gadzinski AJ, Wu SY, Xu M, Greene K, Quanstrom K, et al. Location of recurrence by gallium-68 PSMA-11 PET scan in prostate cancer patients eligible for salvage radiotherapy. Urology. 2019;129:165–71. https://doi.org/10.1016/j.urology.2018.12.055.

    Article  PubMed  Google Scholar 

  28. Roach PJ, Francis R, Emmett L, Hsiao E, Kneebone A, Hruby G, et al. The impact of (68)Ga-PSMA PET/CT on management intent in prostate cancer: results of an Australian prospective multicenter study. J Nucl Med. 2018;59:82–8. https://doi.org/10.2967/jnumed.117.197160.

    Article  CAS  PubMed  Google Scholar 

  29. Michalski JM, Lawton C, El Naqa I, Ritter M, O'Meara E, Seider MJ, et al. Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2010;76:361–8. https://doi.org/10.1016/j.ijrobp.2009.02.006.

    Article  PubMed  Google Scholar 

  30. Pollack A, Karrison TG, Balogh AG Jr, Low D, Bruner DW, Wefel JS, et al. Short term androgen deprivation therapy without or with pelvic lymph node treatment added to prostate bed only salvage radiotherapy: the NRG oncology/RTOG 0534 SPPORT trial. Int J Radiat Oncol Biol Phys. 2018;102.

  31. Muller J, Ferraro DA, Muehlematter UJ, Garcia Schuler HI, Kedzia S, Eberli D, et al. Clinical impact of (68)Ga-PSMA-11 PET on patient management and outcome, including all patients referred for an increase in PSA level during the first year after its clinical introduction. Eur J Nucl Med Mol Imaging. 2019;46:889–900. https://doi.org/10.1007/s00259-018-4203-0.

    Article  CAS  PubMed  Google Scholar 

  32. Mena E, Lindenberg ML, Turkbey IB, Shih JH, Harmon SA, Lim I, et al. (18)F-DCFPyL PET/CT imaging in patients with biochemically recurrent prostate cancer after primary local therapy. J Nucl Med. 2020;61:881–9. https://doi.org/10.2967/jnumed.119.234799.

    Article  CAS  PubMed  Google Scholar 

  33. Rauscher I, Duwel C, Haller B, Rischpler C, Heck MM, Gschwend JE, et al. Efficacy, predictive factors, and prediction Nomograms for (68)Ga-labeled prostate-specific membrane antigen-ligand positron-emission tomography/computed tomography in early biochemical recurrent prostate cancer after radical prostatectomy. Eur Urol. 2018;73:656–61. https://doi.org/10.1016/j.eururo.2018.01.006.

    Article  PubMed  Google Scholar 

  34. Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet. 2020;395:1208–16. https://doi.org/10.1016/S0140-6736(20)30314-7.

    Article  CAS  PubMed  Google Scholar 

  35. Ceci F, Oprea-Lager DE, Emmett L, Adam JA, Bomanji J, Czernin J, et al. E-PSMA: the EANM standardized reporting guidelines v1.0 for PSMA-PET. Eur J Nucl Med Mol Imaging. 2021. https://doi.org/10.1007/s00259-021-05245-y.

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Funding

Cyclotek (Aust) Pty Ltd. for their financial support via access to their GMP-approved product, [18F]DCFPyL PSMA radiopharmaceutical, and through Cyclotek the support of the Australian Government as part of its CRC Projects Program.

Author information

Authors and Affiliations

  1. GenesisCare Cancer Care Research, Melbourne, Australia

    Samantha Koschel, Angela Benson & Michelle Starmans

  2. Department of Surgery, University of Melbourne, Melbourne, Australia

    Samantha Koschel & Lih Ming Wong

  3. Department of Nuclear Medicine, St Vincent’s Hospital Melbourne, Melbourne, Australia

    Kim Taubman

  4. Department of Medical Imaging, St Vincent’s Hospital Melbourne, Melbourne, Australia

    Thomas Sutherland & Kelvin Yap

  5. Faculty of Medicine, University of Melbourne, Melbourne, Australia

    Thomas Sutherland

  6. GenesisCare, Ringwood, Australia

    Michael Chao

  7. GenesisCare, Footscray, Australia

    Mario Guerrieri

  8. La Trobe University Statistics Consultancy Platform, Melbourne, Australia

    Graeme Byrne

  9. GenesisCare, Shepparton, Australia

    Grace Ong

  10. GenesisCare, Albury, Australia

    Craig Macleod

  11. GenesisCare, Berwick, Australia

    Marcus Foo

  12. Department of Surgery, St Vincent’s Hospital, Melbourne, Australia

    Lih Ming Wong

  13. Department of Urology, Northern Hospital, Epping, Australia

    Dennis Gyomber

  14. GenesisCare, St Vincent’s Hospital, Melbourne, Australia

    Michael Ng

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  1. Samantha Koschel
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Corresponding author

Correspondence to Michael Ng.

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St Vincent’s Hospital (Melbourne) Human Research Ethics Committee (EC00343) (Approval Number HREC/18/SCHM/130. Approval date 29.5.2018).

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This article is part of the Topical Collection on Oncology - Genitourinary

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Koschel, S., Taubman, K., Sutherland, T. et al. Patterns of disease detection using [18F]DCFPyL PET/CT imaging in patients with detectable PSA post prostatectomy being considered for salvage radiotherapy: a prospective trial. Eur J Nucl Med Mol Imaging 48, 3712–3722 (2021). https://doi.org/10.1007/s00259-021-05354-8

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