Prostate-specific membrane antigen (PSMA) tracers have increased sensitivity in the detection of prostate cancer, compared with conventional imaging. We assessed the management impact of ¹⁸F-DCFPyL PSMA PET/CT in patients with prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP) and report early biochemical response in patients who underwent radiation treatment. Methods: One hundred patients were enrolled into a prospective study, with a prior RP for prostate cancer, a PSA of 0.2–2.0 ng/mL, and no prior treatment. All patients underwent diagnostic CT and PSMA PET/CT, and management intent was completed at 3 time points (original, post-CT, and post-PSMA) and compared. Patients who underwent radiotherapy with 6-mo PSA response data are presented. Results: Ninety-eight patients are reported, with a median PSA of 0.32 ng/mL (95% CI, 0.28–0.36), pT3a/b disease in 71.4%, and an International Society of Urological Pathology grade group of at least 3 in 59.2%. PSMA PET/CT detected disease in 46.9% of patients, compared with 15.5% using diagnostic CT (PSMA PET, 29.2% local recurrence and 29.6% pelvic nodal disease). A major change in management intent was higher after PSMA than after CT (12.5% vs. 3.2%, P = 0.010), as was a moderate change in intent (31.3% vs. 13.7%, P = 0.001). The most common change was an increase in the recommendation for elective pelvic radiation (from 15.6% to 33.3%), nodal boost (from 0% to 22.9%), and use of concurrent androgen deprivation therapy (ADT) (from 22.9% to 41.7%) from original to post-PSMA intent because of detection of nodal disease. Eighty-six patients underwent ¹⁸F-DCFPyL–guided radiotherapy. Fifty-five of 86 patients either did not receive ADT or recovered after ADT, with an 18-mo PSA response from 0.32 to 0.02 ng/mL; 94.5% of patients had a PSA of no more than 0.20 ng/mL, and 74.5% had a PSA of no more than 0.03 ng/mL. Conclusion: ¹⁸F-DCFPyL PET/CT has a significant impact on management intent in patients being considered for salvage radiotherapy after RP with PSA recurrence. Increased detection of disease, particularly in the pelvic lymph nodes, resulted in increased pelvic irradiation and concurrent ADT use. Early results in patients who are staged with ¹⁸F-DCFPyL PET/CT show a favorable PSA response.

与传统成像相比，前列腺特异性膜抗原 (PSMA) 示踪剂在检测前列腺癌方面具有更高的灵敏度。^{我们评估了18} F-DCFPyL PSMA PET/CT 对根治性前列腺切除术 (RP) 后前列腺特异性抗原 (PSA) 复发患者的管理影响，并报告了接受放射治疗的患者的早期生化反应。方法： 100 名患者被纳入一项前瞻性研究，既往有前列腺癌 RP，PSA 为 0.2–2.0 ng/mL，且无既往治疗。所有患者均接受诊断性 CT 和 PSMA PET/CT，并在 3 个时间点（原始、CT 后和 PSMA 后）完成管理意图并进行比较。提供了接受放疗的患者的 6 个月 PSA 反应数据。结果：报告了 98 名患者，中位 PSA 为 0.32 ng/mL（95% CI，0.28-0.36），71.4% 为 pT3a/b 疾病，国际泌尿病理学会分级组至少为 3 级59.2%。PSMA PET/CT 在 46.9% 的患者中检测到疾病，而使用诊断性 CT 的患者为 15.5%（PSMA PET，局部复发率为 29.2%，盆腔淋巴结疾病为 29.6%）。PSMA 后管理意图的主要变化高于 CT 后（12.5% 对 3.2%，P = 0.010），意图的适度变化也是如此（31.3% 对 13.7%，P= 0.001）。最常见的变化是对选择性盆腔放疗（从 15.6% 到 33.3%）、淋巴结加强（从 0% 到 22.9%）和同时使用雄激素剥夺疗法 (ADT)（从 22.9% 到 41.7）的建议增加%）从原始意图到 PSMA 后意图，因为检测到淋巴结疾病。86 名患者接受了¹⁸ F-DCFPyL 引导的放射治疗。86 名患者中有 55 名未接受 ADT 或在 ADT 后恢复，18 个月 PSA 反应为 0.32 至 0.02 ng/mL；94.5% 的患者 PSA 不超过 0.20 ng/mL，74.5% 的患者 PSA 不超过 0.03 ng/mL。结论： ¹⁸F-DCFPyL PET/CT 对考虑在 RP 伴 PSA 复发后进行挽救性放疗的患者的管理意图有显着影响。增加对疾病的检测，特别是在盆腔淋巴结中，导致增加盆腔照射和同时使用 ADT。^用18 F-DCFPyL PET/CT分期的患者的早期结果显示良好的 PSA 反应。