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18F-DCFPyL PET/CT for primary staging in 160 high-risk prostate cancer patients; metastasis detection rate, influence on clinical management and preliminary results of treatment efficacy

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Prostate-specific membrane antigen (PSMA) PET/CT shows better diagnostic performance for detection of lymph node and bone metastases as compared to conventional imaging. Studies of PSMA PET/CT in primary staging comprise highly selected patient cohorts. This study evaluates 18F-DCFPyL PET/CT as first-line imaging modality for primary staging of high-risk prostate cancer.

Material

From February 2018 until April 2019, all patients with high-risk prostate cancer received 18F-DCFPyL PET/CT for staging of prostate cancer. Baseline characteristics, findings at 18F-DCFPyL PET/CT, number and type of required additional diagnostic procedures, findings at additional diagnostic procedures, and effects of therapy on PSA levels for all patients treated with curative intent were collected and evaluated.

Results

One hundred-sixty patients were included in the study of which 90 (56%) had evidence of metastasized disease (N1, M1a, M1b and, M1c in 49%, 28%, 31%, and 3% respectively). Additional diagnostic imaging was needed in 2/160 patients (1%) because of equivocal findings on 18F-DCFPyL PET/CT. Eighty-one patients had evidence of PSMA-positive lymph node metastases, of whom 39 (48%) had no enlarged lymph nodes on CT; 18F-DCFPyL PET detected additional metastatic lymph nodes in 41/42 patients that had evidence of lymph node metastases on CT. 18F-DCFPyL PET altered patients’ management in 17% of patients.

Conclusion

18F-DCFPyL PET/CT can be used as first-line imaging modality for therapy selection in patients with primary high-risk prostate cancer, without need for further diagnostic imaging procedures in the majority of patients.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands

    M. Wondergem, F. M. van der Zant, W. A. M. Broos & R. J. J. Knol

  2. Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands

    T. A. Roeleveld

  3. Department of Radiation Oncology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands

    R. Donker

  4. Department of Oncology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands

    D. ten Oever

  5. Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands

    R. W. F. Geenen

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  1. M. Wondergem
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Correspondence to M. Wondergem.

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The authors declare that they have no conflict of interest.

Ethical approval

The study passed the local scientific board and approval of the local ethical committee for the present study was waived since the study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (section 1.b WMO, 26th February 1998). Furthermore, as a standard procedure on our department, all included patients gave written consent for usage of their anonymous data for scientific purposes. Informed consent: Need for written.

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

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Wondergem, M., van der Zant, F.M., Broos, W.A.M. et al. 18F-DCFPyL PET/CT for primary staging in 160 high-risk prostate cancer patients; metastasis detection rate, influence on clinical management and preliminary results of treatment efficacy. Eur J Nucl Med Mol Imaging 48, 521–531 (2021). https://doi.org/10.1007/s00259-020-04782-2

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