The Impact of 18F-DCFPyL PSMA PET-CT in the Management of Prostate Cancer Biochemical Recurrence

Abstract

Purpose: We evaluated the findings from 18F-DCFPyL PSMA PET-CTs performed on patients presenting biochemical recurrence (BCR) of prostate cancer (PCa) and assessed its impact on staging. Methods and materials: This was a multicenter retrospective analysis of patients with PCa and BCR who underwent 18F-DCFPyL PSMA PET-CT in 2020. The patients were stratified into two groups: BCR after prostatectomy (PSA ≥ 0.2 ng/mL) or BCR after radiotherapy (PSA ≥ 2 ng/mL + nadir). We analyzed the lesions according to number and location. The Shapiro-Wilk test was used to estimate the distribution of the variables. We calculated representative statistics for the quantitative variables including the mean, standard deviation, median, and interquartile range. The association between qualitative variables was examined using Chi-squared tests. Results: 40 patients with BCR were analyzed; 67.5% presented disease progression, predominantly distant recurrence (42.5%), which was found exclusively in bone; 55% presented ≤5 lesions and of these, 68.2% only presented 1 lesion. There was a change in staging in 66.7% of the cases; 17.7% received ablative treatment with stereotactic radiotherapy (SABR). Conclusions: 18F-DCFPyL PSMA PET-CT represents a new way to manage patients with BCR that, in this study, resulted in a change in staging in 66.7% of cases and early identification of oligometastatic progressions in the subgroup of patients with PSA < 0.5 ng/mL.