J Nucl Med 2021 Dec 16
Predictors of F-DCFPyL-PET/CT Positivity in Patients with Biochemical Recurrence of Prostate Cancer After Local Therapy.   
ABSTRACT
To investigate the factors predicting scan positivity and disease location in patients with biochemical relapse (BCR) prostate cancer (PCa) after primary local therapy using prostate-specific membrane antigen (PSMA)-targeted F-DCFPyL-PET/CT. This is a two-institution study including 245 BCR PCa patients after primary local therapy and negative conventional imaging. Patients underwent F-DCFPyL-PET/CT. Lesion detection rate and disease location were correlated with patient's tumor characteristics, time from the initial therapy, prostate-specific-antigen (PSA) 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 extra-pelvic disease. Overall, 79.2% (194/245) of patients had a positive F-DCFPyL-PET/CT, 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 PSA <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 ( = 195), 24.1% (47/195) had a negative scan, 46.1% (90/195) showed intra-pelvic disease and 29.7% (58/195) extra-pelvic disease. In the post-radiation subgroup ( = 50), F-DCFPyL-PET/CTs were always negative at PSA lower than 1.0 ng/mL and extra-pelvic disease was seen only when PSA >2.0 ng/mL. At multivariate analysis, PSA, PSAdt were independent predictive factors of scan positivity and the presence of extra-pelvic disease in post-surgical patients, with area under the curve (AUC) of 78% and 76%, respectively. PSA and PSAdt were independent predictors of the presence of extra-pelvic disease in the post-radiation cohort, with AUC 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 years, p<0.001). F-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/visceral lesions are associated with shorter intervals from treatment compared to prostate-bed-only recurrences. These tools might guide clinicians to select the most suitable candidates for F-DCFPyL-PET/CT imaging.

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