Advertisement

A Prospective Study of 18F-DCFPyL PSMA PET/CT Restaging in Recurrent Prostate Cancer following Primary External Beam Radiotherapy or Brachytherapy

Published:November 12, 2019DOI:https://doi.org/10.1016/j.ijrobp.2019.11.001

      Purpose

      Radio-recurrent prostate cancer is typically detected by a rising prostate-specific antigen and may reflect local or distant disease. Positron emission tomography (PET) radiotracers targeting prostate-specific membrane antigen, such as 18F-DCFPyL have shown promise in restaging men with recurrent disease postprostatectomy but are less well characterized in the setting of radio-recurrent disease.

      Methods and Materials

      A prospective, multi-institutional study was conducted to evaluate the effect of 18F-DCFPyL PET/computed tomography (CT) when added to diagnostic imaging (DI; CT abdomen and pelvis, bone scan, multiparametric magnetic resonance imaging pelvis) for men with radio-recurrent prostate cancer. All men were imaged with DI and subsequently underwent 18F-DCFPyL PET/CT with local and central reads. Tie break reads were performed as required. Management questionnaires were completed after DI and again after 18F-DCFPyL PET/CT. Discordance in patterns of disease detected with 18F-DCFPyL PET/CT versus DI and changes in management were characterized.

      Results

      Seventy-nine men completed the study. Most men had T1 disease (62%) and Gleason score <7 (95%). Median prostate-specific antigen at diagnosis was 7.4 ng/mL and at relapse was 4.8 ng/mL. DI detected isolated intraprostatic recurrence in 38 out of 79 men (48%), regional nodal recurrence in 9 out of 79 (11%), distant disease in 12 out of 79 (15%), and no disease in 26 out of 79 (33%). 18F-DCFPyL PET/CT detected isolated intraprostatic recurrence in 38 out of 79 men (48%), regional nodal recurrence in 21 out of 79 (27%), distant disease in 24 out of 79 (30%), and no disease in 10 out of 79 (13%). DI identified 8 out of 79 (10%) patients to have oligometastatic disease, compared with 21 out of 79 (27%) with 18F-DCFPyL PET/CT. 18F-DCFPyL PET/CT changed proposed management in 34 out of 79 (43%) patients.

      Conclusions

      18F-DCFPyL PET/CT identified extraprostatic disease in twice as many men with radio-recurrent prostate cancer compared with DI and detected a site of recurrence in 87% of men compared with 67% with DI. Furthermore, 18F-DCFPyL PET/CT identified potentially actionable disease (prostate only recurrence or oligometastatic disease) in 75% of men and changed proposed management in 43% of men.
      To read this article in full you will need to make a payment
      ASTRO Member Login
      ASTRO Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Catton C.N.
        • Lukka H.
        • Gu C.S.
        • et al.
        Randomized trial of a hypofractionated radiation regimen for the treatment of localized prostate cancer.
        J Clin Oncol. 2017; 35: 1884-1890
        • Lee W.R.
        • Dignam J.J.
        • Amin M.B.
        • et al.
        Randomized phase III noninferiority study comparing two fractionation schedules in patients with low-risk prostate cancer.
        J Clin Oncol. 2016; 34: 2325-2332
        • Dearnaley D.
        • Syndikus I.
        • Mossop H.
        • et al.
        Conventional versus hypofractionated high-dose intensity modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial.
        Lancet Oncol. 2016; 17: 1047-1060
        • Incrocci L.
        • Wortel R.C.
        • Alemayehu W.G.
        • et al.
        Hypofractionated versus conventionally fractionated radiotherapy for patients with localised prostate cancer (HYPRO): Final efficacy results from a randomised, multicentre, open-label, phase 3 trial.
        Lancet Oncol. 2016; 17: 1061-1069
        • Roach 3rd, M.
        • Hanks G.
        • Thames Jr., H.
        • et al.
        Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: Recommendations of the RTOG-ASTRO Phoenix Consensus Conference.
        Int J Radiat Oncol. 2006; 65: 965-974
        • Cary K.C.
        • Paciorek A.
        • Fuldeore M.J.
        • Carroll P.R.
        • Cooperberg M.R.
        Temporal trends and predictors of salvage cancer treatment after failure following radical prostatectomy or radiation therapy: An analysis from the CaPSURE registry.
        Cancer. 2014; 120: 507-512
        • Tran H.
        • Kwok J.
        • Pickles T.
        • Tyldesley S.
        • Black P.C.
        Underutilization of local salvage therapy after radiation therapy for prostate cancer11Funding: UBC Summer Student Research Program.
        Urol Oncol Semin Orig Investig. 2014; 32: 701-706
        • Mandel P.
        • Steuber T.
        • Ahyai S.
        • et al.
        Salvage radical prostatectomy for recurrent prostate cancer: Verification of European Association of Urology guideline criteria.
        BJU Int. 2016; 117: 55-61
        • Rosoff J.S.
        • Savage S.J.
        • Prasad S.M.
        Salvage radical prostatectomy as management of locally recurrent prostate cancer: Outcomes and complications.
        World J Urol. 2013; 31: 1347-1352
        • Pisters L.L.
        • Leibovici D.
        • Blute M.
        • et al.
        Locally recurrent prostate cancer after initial radiation therapy: A comparison of salvage radical prostatectomy versus cryotherapy.
        J Urol. 2009; 182: 517-527
        • Paparel P.
        • Cronin A.M.
        • Savage C.
        • Scardino P.T.
        • Eastham J.A.
        Oncologic outcome and patterns of recurrence after salvage radical prostatectomy.
        Eur Urol. 2009; 55: 404-411
        • Sanderson K.M.
        • Penson D.F.
        • Cai J.
        • et al.
        Salvage radical prostatectomy: Quality of life outcomes and long-term oncological control of radiorecurrent prostate cancer.
        J Urol. 2006; 176: 2025-2032
        • Chade D.C.
        • Eastham J.
        • Graefen M.
        • et al.
        Cancer control and functional outcomes of salvage radical prostatectomy for radiation-recurrent prostate cancer: A systematic review of the literature.
        Eur Urol. 2012; 61: 961-971
        • Crouzet S.
        • Blana A.
        • Murat F.J.
        • et al.
        Salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after failed radiation therapy: Multi-institutional analysis of 418 patients.
        BJU Int. 2017; 119: 896-904
        • Jones T.A.
        • Chin J.
        • Mcleod D.
        • et al.
        High intensity focused ultrasound for radiorecurrent prostate cancer: A North American clinical trial.
        J Urol. 2018; 199: 133-139
        • Murat F.J.
        • Poissonnier L.
        • Rabilloud M.
        • et al.
        Midterm Results demonstrate salvage high-intensity focused ultrasound (HIFU) as an effective and acceptably morbid salvage treatment option for locally radiorecurrent prostate cancer.
        Eur Urol. 2009; 55: 640-649
        • Izawa J.I.
        • Madsen L.T.
        • Scott S.M.
        • et al.
        Salvage cryotherapy for recurrent prostate cancer after radiotherapy: Variables affecting patient outcome.
        J Clin Oncol. 2002; 20: 2664-2671
        • Williams A.K.
        • Martínez C.H.
        • Lu C.
        • et al.
        Disease-free survival following salvage cryotherapy for biopsy-proven radio-recurrent prostate cancer.
        Eur Urol. 2011; 60: 405-410
        • Ismail M.
        • Ahmed S.
        • Kastner C.
        • Davies J.
        Salvage cryotherapy for recurrent prostate cancer after radiation failure: A prospective case series of the first 100 patients.
        BJU Int. 2007; 100: 760-764
        • de Castro Abreu A.L.
        • Bahn D.
        • Leslie S.
        • et al.
        Salvage focal and salvage total cryoablation for locally recurrent prostate cancer after primary radiation therapy.
        BJU Int. 2013; 112: 298-307
        • Li Y.H.
        • Elshafei A.
        • Agarwal G.
        • et al.
        Salvage focal prostate cryoablation for locally recurrent prostate cancer after radiotherapy: Initial results from the cryo on-line data registry.
        Prostate. 2015; 75: 1-7
        • Łyczek J.
        • Kawczyńska M.M.
        • Garmol D.
        • et al.
        HDR brachytherapy as a solution in recurrences of locally advanced prostate cancer.
        J Contemp Brachytherapy. 2009; 1: 105-108
        • Wojcieszek P.
        • Szlag M.
        • Głowacki G.
        • et al.
        Salvage high-dose-rate brachytherapy for locally recurrent prostate cancer after primary radiotherapy failure.
        Radiother Oncol. 2016; 119: 405-410
        • Vargas C.
        • Swartz D.
        • Vashi A.
        • et al.
        Salvage brachytherapy for recurrent prostate cancer.
        Brachytherapy. 2014; 13: 53-58
        • Crook J.M.
        • Zhang P.
        • Pisansky T.M.
        • et al.
        A prospective phase 2 trial of transperineal ultrasound-guided brachytherapy for locally recurrent prostate cancer after external beam radiation therapy (NRG Oncology/RTOG-0526).
        Int J Radiat Oncol. 2019; 103: 335-343
        • Grado G.L.
        • Collins J.M.
        • Kriegshauser J.S.
        • et al.
        Salvage brachytherapy for localized prostate cancer after radiotherapy failure.
        Urology. 1999; 53: 2-10
        • Henríquez I.
        • Sancho G.
        • Hervás A.
        • et al.
        Salvage brachytherapy in prostate local recurrence after radiation therapy: Predicting factors for control and toxicity.
        Radiat Oncol. 2014; 9: 102
        • Kollmeier M.A.
        • McBride S.
        • Taggar A.
        • et al.
        Salvage brachytherapy for recurrent prostate cancer after definitive radiation therapy: A comparison of low-dose-rate and high-dose-rate brachytherapy and the importance of prostate-specific antigen doubling time.
        Brachytherapy. 2017; 16: 1091-1098
        • Yamada Y.
        • Kollmeier M.A.
        • Pei X.
        • et al.
        A Phase II study of salvage high-dose-rate brachytherapy for the treatment of locally recurrent prostate cancer after definitive external beam radiotherapy.
        Brachytherapy. 2014; 13: 111-116
        • Fuller D.B.
        • Wurzer J.
        • Shirazi R.
        • et al.
        High-dose-rate stereotactic body radiation therapy for postradiation therapy locally recurrent prostatic carcinoma: Preliminary prostate-specific antigen response, disease-free survival, and toxicity assessment.
        Pract Radiat Oncol. 2015; 5: e615-e623
        • Leroy T.
        • Lacornerie T.
        • Bogart E.
        • et al.
        Salvage robotic SBRT for local prostate cancer recurrence after radiotherapy: Preliminary results of the Oscar Lambret Center.
        Radiat. Oncol. 2017; 12: 95
        • Zerini D.
        • Jereczek-Fossa B.A.
        • Fodor C.
        • et al.
        Salvage image guided intensity modulated or stereotactic body reirradiation of local recurrence of prostate cancer.
        Br J Radiol. 2015; 88: 20150197
        • Vavassori A.
        • Jereczek-Fossa B.A.
        • Beltramo G.
        • et al.
        Image guided robotic radiosurgery as salvage therapy for locally recurrent prostate cancer after external beam irradiation: Retrospective feasibility study on six cases.
        Tumori. 2010; 96: 71-75
        • Palma D.A.
        • Olson R.
        • Harrow S.
        • et al.
        Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): A randomised, phase 2, open-label trial.
        Lancet. 2019; 18: 2051-2058
        • Ost P.
        • Reynders D.
        • Decaestecker K.
        • et al.
        Surveillance or metastasis-directed therapy for oligometastatic prostate cancer recurrence: A prospective, randomized, multicenter phase II trial.
        J Clin Oncol. 2018; 36: 446-453
        • Siva S.
        • Bressel M.
        • Murphy D.G.
        • et al.
        Stereotactic abative body radiotherapy (SABR) for oligometastatic prostate cancer: A prospective clinical trial.
        Eur Urol. 2018; 74: 455-462
        • Palacios-Eito A.
        • Béjar-Luque A.
        • Rodríguez-Liñán M.
        • García-Cabezas S.
        Oligometastases in prostate cancer: Ablative treatment.
        World J Clin Oncol. 2019; 10: 38-51
        • Tetreault-Laflamme A.
        • Crook J.
        Options for salvage of radiation failures for prostate cancer.
        Semin Radiat Oncol. 2017; 27: 67-78
        • Philippou Y.
        • Parker R.A.
        • Volanis D.
        • Gnanapragasam V.J.
        Comparative oncologic and toxicity outcomes of salvage radical prostatectomy versus nonsurgical therapies for radiorecurrent prostate cancer: A meta-regression analysis.
        Eur Urol Focus. 2016; 2: 158-171
        • De Visschere P.J.L.
        • Standaert C.
        • Fütterer J.J.
        • et al.
        A systematic review on the role of imaging in early recurrent prostate cancer.
        Eur Urol Oncol. 2019; 2: 47-76
        • Dietlein F.1
        • Kobe C.
        • Neubauer S.
        • et al.
        PSA-stratified performance of 18F- and 68Ga-PSMA PET in patients with biochemical recurrence of prostate cancer.
        J Nucl Med. 2017; 58: 947-952
        • Wondergem M.
        • van der Zant F.M.
        • Knol R.J.J.
        • et al.
        18F-DCFPyL PET/CT in the detection of prostate cancer at 60 and 120 minutes: Detection rate, image quality, activity kinetics, and biodistribution.
        J Nucl Med. 2017; 58: 1797-1804
        • Phillips R.M.
        • Gorin M.A.
        • Rowe S.P.
        • et al.
        Complete biochemical response after stereotactic ablative radiotherapy of an isolated prostate cancer pelvic soft tissue recurrence detected by 18F-DCFPyL PET/CT.
        Urol Case Rep. 2018; 16: 86-88
        • von Eyben F.E.
        • Picchio M.
        • von Eyben R.
        • Rhee H.
        • Bauman G.
        68Ga-labeled prostate-specific membrane antigen ligand positron emission tomography/computed tomography for prostate cancer: A systematic review and meta-analysis.
        Eur Urol Focus. 2016; 4: 686-693
        • Szabo Z.
        • Mena E.
        • Rowe S.P.
        • et al.
        Initial evaluation of [18F]DCFPyL for prostate-specific membrane antigen (PSMA)-targeted PET imaging of prostate cancer.
        Mol Imaging Biol. 2015; 17: 565-574
        • Dietlein M.
        • Kobe C.
        • Kuhnert G.
        • et al.
        Comparison of [18F]DCFPyL and [68Ga]Ga-PSMA-HBED-CC for PSMA-PET imaging in patients with relapsed prostate cancer.
        Mol. Imaging Biol. 2015; 17: 575-584
        • Szymanski K.M.
        • Wei J.T.
        • Dunn R.L.
        • Sanda M.G.
        Development and validation of an abbreviated version of the expanded prostate cancer index composite instrument for measuring health-related quality of life among prostate cancer survivors.
        Urology. 2010; 76: 1245-1250
        • Esper P.
        • Mo F.
        • Chodak G.
        • Sinner M.
        • Cella D.
        • Pienta K.J.
        Measuring quality of life in men with prostate cancer using the functional assessment of cancer therapy-prostate instrument.
        Urology. 1997; 50: 920-928
        • Ost P.
        • Bossi A.
        • Decaestecker K.
        • et al.
        Metastasis-directed therapy of regional and distant recurrences after curative treatment of prostate cancer: A systematic review of the literature.
        Eur Urol. 2015; 67: 852-863
        • Siddiqui K.M.
        • Billia M.
        • Al-Zahrani A.
        • et al.
        Long-term oncologic outcomes of salvage cryoablation for radio-recurrent prostate cancer.
        J Urol. 2016; 196: 1105-1111
        • Murgic J.
        • Morton G.
        • Loblaw A.
        • et al.
        Focal salvage high dose-rate brachytherapy for locally recurrent prostate cancer after primary radiation therapy failure: Results from a prospective clinical trial.
        Int J Radiat Oncol. 2018; 102: 561-567
        • Nguyen P.L.
        • Chen M.H.
        • D'Amico A.V.
        • et al.
        Magnetic resonance image guided salvage brachytherapy after radiation in select men who initially presented with favorable-risk prostate cancer: A prospective phase 2 study.
        Cancer. 2007; 110: 1485-1492
        • Maenhout M.
        • Peters M.
        • van Vulpen M.
        • et al.
        Focal MRI-guided salvage high-dose-rate brachytherapy in patients with radiorecurrent prostate cancer.
        Technol Cancer Res Treat. 2017; 16: 1194-1201
        • Siddiqui K.M.
        • Billia M.
        • Arifin A.
        • et al.
        Pathological, oncologic and functional outcomes of a prospective registry of salvage high intensity focused ultrasound ablation for radiorecurrent prostate cancer.
        J Urol. 2017; 197: 97-102
        • Baco E.
        • Gelet A.
        • Crouzet S.
        • et al.
        Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: A prospective two-centre study.
        BJU Int. 2014; 114: 532-540
      1. Perera M, Papa N, Roberts M, et al. Gallium-68 prostate-specific membrane antigen positron emission tomography in advanced prostate cancer—Updated diagnostic utility, sensitivity, specificity, and distribution of prostate-specific membrane antigen-avid lesions: A systematic review and meta-analysis. Eur Urol. [Epub ahead of print]

        • Han S.
        • Woo S.
        • Kim Y.J.
        • Suh C.H.
        Impact of 68 Ga-PSMA PET on the management of patients with prostate cancer: A systematic review and meta-analysis.
        Eur Urol. 2018; 74: 179-190
        • Rousseau E.
        • Wilson D.
        • Lacroix-Poisson F.
        • et al.
        A prospective study on 18 F-DCFPyL PSMA PET/CT imaging in biochemical recurrence of prostate cancer.
        J Nucl Med. 2019; 60: 1587-1593
        • Rosenkrantz A.B.
        • Ayoola A.
        • Hoffman D.
        • et al.
        The learning curve in prostate mri interpretation: Self-directed learning versus continual reader feedback.
        AJR Am J Roentgenol. 2017; 208: W92-W100
        • Théberge I.
        • Chang S.L.
        • Vandal N.
        • et al.
        Radiologist interpretive volume and breast cancer screening accuracy in a Canadian organized screening program.
        JNCI J Natl Cancer Inst. 2014; 106: djt461
        • Crook J.M.
        • O'Callaghan C.J.
        • Duncan G.
        • et al.
        Intermittent androgen suppression for rising psa level after radiotherapy.
        N Engl J Med. 2012; 367: 895-903
        • Metser U.
        • Berlin A.
        • Halankar J.
        • et al.
        18F-Fluorocholine PET whole-body MRI in the staging of high-risk prostate cancer.
        AJR A J Roentgenol. 2018; 210: 635-640
        • van Leeuwen P.J.
        • Donswijk M.
        • Nandurkar R.
        • et al.
        Gallium-68-prostate-specific membrane antigen (68 Ga-PSMA) positron emission tomography (PET)/computed tomography (CT) predicts complete biochemical response from radical prostatectomy and lymph node dissection in intermediate- and high-risk prostate cancer.
        BJU Int. 2019; 124: 62-68
      2. Kimura S, Abufaraj M, Janisch F, et al. Performance of [68Ga] Ga-PSMA 11 PET for detecting prostate cancer in the lymph nodes before salvage lymph node dissection: A systematic review and meta-analysis. Prostate Cancer Prostatic Dis. [Epub ahead of print]. https://doi.org/10.1038/s41391-019-0156-z.

        • Fendler W.P.
        • Calais J.
        • Eiber M.
        • et al.
        Assessment of 68Ga-PSMA-11 PET accuracy in localizing recurrent prostate cancer.
        JAMA Oncol. 2019; 5: 856

      Linked Article

      Comments

      Commenting Guidelines

      To submit a comment for a journal article, please use the space above and note the following:

      • We will review submitted comments as soon as possible, striving for within two business days.
      • This forum is intended for constructive dialogue. Comments that are commercial or promotional in nature, pertain to specific medical cases, are not relevant to the article for which they have been submitted, or are otherwise inappropriate will not be posted.
      • We require that commenters identify themselves with names and affiliations.
      • Comments must be in compliance with our Terms & Conditions.
      • Comments are not peer-reviewed.