Esther Mena1, Steven P Rowe2, Joanna H Shih3, Liza Lindenberg4, Baris Turkbey4, Aloyse Fourquet4, Frank I Lin4, Stephen Adler5, Philip Eclarinal4, Yolanda L McKinney4, Deborah E Citrin6, William Dahut7, Bradford J Wood8, Richard Chang8, Elliot Levy8, Maria Merino9, Michael A Gorin10, Martin G Pomper2, Peter A Pinto11, Janet F Eary12, Peter L Choyke4, Kenneth J Pienta10. 1. Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; esther.menagonzalez@nih.gov. 2. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Division of Cancer Treatment and Diagnosis: Biometric Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. 4. Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. 5. Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland. 6. Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. 7. Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. 8. Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. 9. Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. 10. James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland. 11. Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; and. 12. Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Abstract
Our objective was to investigate the factors predicting scan positivity and disease location in patients with biochemical recurrence (BCR) of prostate cancer (PCa) after primary local therapy using prostate-specific membrane antigen-targeted 18F-DCFPyL PET/CT. Methods: This was a 2-institution study including 245 BCR PCa patients after primary local therapy and negative results on conventional imaging. The patients underwent 18F-DCFPyL PET/CT. We tested for correlations of lesion detection rate and disease location with tumor characteristics, time from initial therapy, prostate-specific antigen (PSA) level, and PSA doubling time (PSAdt). Multivariate logistic regression analyses were used to determine predictors of a positive scan. Regression-based coefficients were used to develop nomograms predicting scan positivity and extrapelvic disease. Results: Overall, 79.2% (194/245) of patients had a positive 18F-DCFPyL PET/CT result, with detection rates of 48.2% (27/56), 74.3% (26/35), 84% (37/44), 96.7% (59/61), and 91.8% (45/49) for PSAs of <0.5, 0.5 to <1.0, 1.0 to <2.0, 2.0 to <5.0, and ≥5.0 ng/mL, respectively. Patients with lesions confined to the pelvis had lower PSAs than those with distant sites (1.6 ± 3.5 vs. 3.0 ± 6.3 ng/mL, P < 0.001). In patients treated with prostatectomy (n = 195), 24.1% (47/195) had a negative scan result, 46.1% (90/195) showed intrapelvic disease, and 29.7% (58/195) showed extrapelvic disease. In the postradiation subgroup (n = 50), 18F-DCFPyL PET/CT was always negative at a PSA lower than 1.0 ng/mL and extrapelvic disease was seen only when PSA was greater than 2.0 ng/mL. At multivariate analysis, PSA and PSAdt were independent predictive factors of scan positivity and the presence of extrapelvic disease in postsurgical patients, with area under the curve of 78% and 76%, respectively. PSA and PSAdt were independent predictors of the presence of extrapelvic disease in the postradiation cohort, with area under the curve of 85%. Time from treatment to scan was significantly longer for prostatectomy-bed-only recurrences than for those with bone or visceral disease (6.2 ± 6.4 vs. 2.4 ± 1.3 y, P < 0.001). Conclusion: 18F-DCFPyL PET/CT offers high detection rates in BCR PCa patients. PSA and PSAdt are able to predict scan positivity and disease location. Furthermore, the presence of bone or visceral lesions is associated with shorter intervals from treatment than are prostate-bed-only recurrences. These tools might guide clinicians to select the most suitable candidates for 18F-DCFPyL PET/CT imaging.
Our objective was to investigate the factors predicting scan positivity and disease location in patients with biochemical recurrence (BCR) of prostate cancer (PCa) after primary local therapy using prostate-specific membrane antigen-targeted 18F-DCFPyL PET/CT. Methods: This was a 2-institution study including 245 BCR PCa patients after primary local therapy and negative results on conventional imaging. The patients underwent 18F-DCFPyL PET/CT. We tested for correlations of lesion detection rate and disease location with tumor characteristics, time from initial therapy, prostate-specific antigen (PSA) level, and PSA doubling time (PSAdt). Multivariate logistic regression analyses were used to determine predictors of a positive scan. Regression-based coefficients were used to develop nomograms predicting scan positivity and extrapelvic disease. Results: Overall, 79.2% (194/245) of patients had a positive 18F-DCFPyL PET/CT result, with detection rates of 48.2% (27/56), 74.3% (26/35), 84% (37/44), 96.7% (59/61), and 91.8% (45/49) for PSAs of <0.5, 0.5 to <1.0, 1.0 to <2.0, 2.0 to <5.0, and ≥5.0 ng/mL, respectively. Patients with lesions confined to the pelvis had lower PSAs than those with distant sites (1.6 ± 3.5 vs. 3.0 ± 6.3 ng/mL, P < 0.001). In patients treated with prostatectomy (n = 195), 24.1% (47/195) had a negative scan result, 46.1% (90/195) showed intrapelvic disease, and 29.7% (58/195) showed extrapelvic disease. In the postradiation subgroup (n = 50), 18F-DCFPyL PET/CT was always negative at a PSA lower than 1.0 ng/mL and extrapelvic disease was seen only when PSA was greater than 2.0 ng/mL. At multivariate analysis, PSA and PSAdt were independent predictive factors of scan positivity and the presence of extrapelvic disease in postsurgical patients, with area under the curve of 78% and 76%, respectively. PSA and PSAdt were independent predictors of the presence of extrapelvic disease in the postradiation cohort, with area under the curve of 85%. Time from treatment to scan was significantly longer for prostatectomy-bed-only recurrences than for those with bone or visceral disease (6.2 ± 6.4 vs. 2.4 ± 1.3 y, P < 0.001). Conclusion: 18F-DCFPyL PET/CT offers high detection rates in BCR PCa patients. PSA and PSAdt are able to predict scan positivity and disease location. Furthermore, the presence of bone or visceral lesions is associated with shorter intervals from treatment than are prostate-bed-only recurrences. These tools might guide clinicians to select the most suitable candidates for 18F-DCFPyL PET/CT imaging.
Authors: Michael S Cookson; Gunnar Aus; Arthur L Burnett; Edith D Canby-Hagino; Anthony V D'Amico; Roger R Dmochowski; David T Eton; Jeffrey D Forman; S Larry Goldenberg; Javier Hernandez; Celestia S Higano; Stephen R Kraus; Judd W Moul; Catherine Tangen; J Brantley Thrasher; Ian Thompson Journal: J Urol Date: 2007-02 Impact factor: 7.450
Authors: Michael A Gorin; Steven P Rowe; Hiten D Patel; Igor Vidal; Margarita Mana-Ay; Mehrbod S Javadi; Lilja B Solnes; Ashley E Ross; Edward M Schaeffer; Trinity J Bivalacqua; Alan W Partin; Kenneth J Pienta; Zsolt Szabo; Angelo M De Marzo; Martin G Pomper; Mohamad E Allaf Journal: J Urol Date: 2017-07-20 Impact factor: 7.450
Authors: Zsolt Szabo; Esther Mena; Steven P Rowe; Donika Plyku; Rosa Nidal; Mario A Eisenberger; Emmanuel S Antonarakis; Hong Fan; Robert F Dannals; Ying Chen; Ronnie C Mease; Melin Vranesic; Akrita Bhatnagar; George Sgouros; Steve Y Cho; Martin G Pomper Journal: Mol Imaging Biol Date: 2015-08 Impact factor: 3.488
Authors: Steven P Rowe; Katarzyna J Macura; Anthony Ciarallo; Esther Mena; Amanda Blackford; Rosa Nadal; Emmanuel S Antonarakis; Mario A Eisenberger; Michael A Carducci; Ashley E Ross; Philip W Kantoff; Daniel P Holt; Robert F Dannals; Ronnie C Mease; Martin G Pomper; Steve Y Cho Journal: J Nucl Med Date: 2015-10-22 Impact factor: 10.057
Authors: Francesco Ceci; Daniela E Oprea-Lager; Louise Emmett; Judit A Adam; Jamshed Bomanji; Johannes Czernin; Matthias Eiber; Uwe Haberkorn; Michael S Hofman; Thomas A Hope; Rakesh Kumar; Steven P Rowe; Sarah M Schwarzenboeck; Stefano Fanti; Ken Herrmann Journal: Eur J Nucl Med Mol Imaging Date: 2021-02-19 Impact factor: 9.236
Authors: Esther Mena; Maria Liza Lindenberg; Ismail Baris Turkbey; Joanna H Shih; Stephanie A Harmon; Ilhan Lim; Frank Lin; Stephen Adler; Philip Eclarinal; Yolanda L McKinney; Deborah Citrin; William Dahut; Bradford J Wood; Venkatesh Krishnasamy; Richard Chang; Elliot Levy; Maria Merino; Peter Pinto; Janet F Eary; Peter L Choyke Journal: J Nucl Med Date: 2019-11-01 Impact factor: 11.082
Authors: Frederik L Giesel; Karina Knorr; Fabian Spohn; Leon Will; Tobias Maurer; Paul Flechsig; Oliver Neels; Kilian Schiller; Horacio Amaral; Wolfgang A Weber; Uwe Haberkorn; Markus Schwaiger; Clemens Kratochwil; Peter Choyke; Vasko Kramer; Klaus Kopka; Matthias Eiber Journal: J Nucl Med Date: 2018-07-24 Impact factor: 10.057