Utilization of Salvage and Systemic Therapies for Recurrent Prostate Cancer as a Result of 18 F-DCFPyL PET/CT Restaging

• Published in: Advances in radiation oncology Vol. 6; no. 1; p. 100553
• Main Authors: Liu, Wei, Zukotynski, Katherine, Emmett, Louise, Chung, Hans T, Chung, Peter, Wolfson, Robert, Rachinsky, Irina, Kapoor, Anil, Metser, Ur, Loblaw, Andrew, Morton, Gerard, Sexton, Tracy, Lock, Michael, Helou, Joelle, Berlin, Alejandro, Boylan, Colm, Archer, Susan, Pond, Gregory R, Bauman, Glenn
• Format: Journal Article
• Language: English
• Published: United States 01.01.2021
• ISSN: 2452-1094; 2452-1094

Our purpose was to investigate the effect of the addition of prostate-specific membrane antigen (PSMA)-targeted positron emission tomography/computed tomography (PET/CT) in patients with recurrent prostate cancer post-primary radiation therapy. A prospective, multi-institutional clinical trial evaluated 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid ( F-DCFPyL) PET/CT restaging in 79 men with recurrent prostate cancer post-primary radiation therapy. We report actual patient management and compare this with proposed management both before and after PSMA-targeted PET/CT. Most patients (59%) had a major change in actual management compared with pre-PET/CT proposed management. The rate of major change was underestimated by immediately post-PET/CT surveys (32%). Eighteen patients with PSMA avidity in the prostate gland suspicious for malignancy had a prostate biopsy. Sensitivity, specificity, and positive predictive values of PSMA uptake in the prostate were 86%, 67%, and 92%, respectively. Thirty percent of patients had directed salvage therapy and 41% underwent systemic therapy. Eleven out of 79 patients (14%) had high-dose-rate brachytherapy alone for local recurrence, and 91% were free of recurrence at a median follow-up of 20 months. Most patients had a major change in actual management compared with pre-PSMA-targeted PET/CT planned management, and this was underestimated by post-PET/CT questionnaires.