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

Abstract

PURPOSE:

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.

METHODS AND MATERIALS:

A prospective, multi-institutional clinical trial evaluated 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-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.

RESULTS:

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.

CONCLUSIONS:

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.

• Authors: Wei Liu, Katherine Zukotynski, Louise Emmett, Hans T Chung, Peter Chung, Robert Wolfson, Irina Rachinsky, Anil Kapoor, Ur Metser, Andrew Loblaw, Gerard Morton, Tracy Sexton, Michael Lock, Joelle Helou, Alejandro Berlin, Colm Boylan, Susan Archer, Gregory R Pond, Glenn Bauman
• Journal: Advances in radiation oncology (Adv Radiat Oncol) 2021 Jan-Feb Vol. 6 Issue 1 Pg. 100553 ISSN: 2452-1094 [Print] United States
• PMID: 33521396 (Publication Type: Journal Article)
• Copyright: © 2020 The Author(s).