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Evaluating Biochemically Recurrent Prostate Cancer: Histologic Validation of 18F-DCFPyL PET/CT with Comparison to
Liza Lindenberg1, Esther Mena1, Baris Turkbey1
1From the Molecular Imaging Program, National Cancer Institute, Building 10, Room B3B47A, Bethesda, MD 20892 (L.L., E.M., B.T., I.L., F.L., A.T., Y.L.M., P.E., P.L.C.); Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Md (J.H.S.); National Cancer Institute Biometrics Research Program Contract, General Dynamics Information Technology, Falls Church, Va (S.E.R.); Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Bethesda, Md (S.A.H.); Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md (D.E.C.); Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (W.D., R.M.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Md (B.J.W., V.K., R.C., E.L.); Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (P.P.); and Cancer Imaging Program, National Cancer Institute, Bethesda, Md (J.F.E.).
Prostate-specific membrane antigen PET/CT using 18F-DCFPyL shows high accuracy for detecting recurrent prostate cancer. This method improves upon multiparametric MRI, particularly in identifying pelvic lymph node involvement.
Area of Science:
- Nuclear Medicine
- Radiology
- Oncology
Background:
- Prostate cancer recurrence affects up to 40% of men post-definitive treatment.
- Prostate-specific membrane antigen (PSMA) PET agents like 18F-DCFPyL offer potential for improved recurrence detection over multiparametric MRI.
- Histopathologic validation of PSMA PET imaging for recurrent prostate cancer is limited.
Purpose of the Study:
- To determine the sensitivity, specificity, and positive predictive value (PPV) of 18F-DCFPyL PET/CT.
- To compare the diagnostic performance of 18F-DCFPyL PET/CT with pelvic multiparametric MRI.
- To assess these metrics in men with biochemically recurrent prostate cancer.
Main Methods:
- Prospective recruitment of men with rising PSA levels post-treatment and negative conventional imaging.
- Participants underwent both 18F-DCFPyL PET/CT and 3.0-T pelvic multiparametric MRI.
- Histopathologic analysis was used for validation of imaging findings.
Main Results:
- 18F-DCFPyL PET/CT demonstrated high specificity (91%) and PPV (86%) for detecting recurrence, validated histologically.
- 18F-DCFPyL identified more pelvic lymph nodes compared to MRI (128 vs. 23).
- Adding 18F-DCFPyL PET/CT to multiparametric MRI improved overall PPV by 38% (P=.02).
Conclusions:
- 18F-DCFPyL PET/CT findings are histologically validated, showing high specificity and PPV for recurrent prostate cancer.
- 18F-DCFPyL PET/CT detects more pelvic lymph nodes than MRI.
- This PSMA PET agent enhances diagnostic accuracy when combined with multiparametric MRI for recurrent prostate cancer detection.
