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Initial [18F]DCFPyL PET/CT in treatment-naïve prostate cancer: correlation with post-ADT PSA outcomes and recurrence

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Abstract

Purpose

Positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) targeting tracers has emerged as a valuable diagnostic tool for prostate cancer (PCa), androgen deprivation therapy (ADT) stands as the cornerstone treatment for advanced PCa, yet forecasting the response to hormonal therapy poses a significant clinical hurdle.

Methods

In a prospective cohort of 86 PCa patients undergoing short-term ADT, this study evaluated the prognostic potential of [18F]DCFPyL PET/CT scans. Comprehensive data encompassing clinical profiles, baseline prostate-specific antigen (PSA) levels, and imaging metrics were assessed. We developed predictive models for assessing decreases in PSA levels (PSA50 and PSA70) based on a combination of PET-related parameters and clinical factors. Kaplan-Meier survival analysis was utilized to ascertain the prognostic value of PET-based metrics.

Results

In this study, elevated [18F]DCFPyL uptake within the primary tumor, as indicated by a SUV ≥ 6.78 (p = 0.0024), and a reduction in the tumor volume (TV) of primary PSMA-avid tumor with PSMA-TV < 41.96 cm3 (p = 0.038), as well as an increased burden of metastatic PSMA-avid tumor, with PSMA-TV (PSMA-TV ≥ 71.39 cm3) (p = 0.012) were identified in association with diminished progression-free survival (PFS). PET and clinical parameters demonstrated constrained predictive capacity for PSA50 response as indicated by an area under the curve (AUC) of 0.442.

Conclusion

Our study revealed that pretreatment [18F]DCFPyL uptake in primary or metastatic tumor sites is prognostically relevant in high-risk PCa patients undergoing ADT.

Further research is needed to develop robust predictive models in this multifaceted landscape of PCa management.

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Data availability

The dataset generated during and/or analyzed during the current study is available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Qilu Hospital of Shandong University, No. 107, Cultural West Road, Jinan, 250012, China

    Yuekai Li, Shuai Huang, Kaiyue Li & Xin Li

  2. Evomics Medical Technology Co., Ltd, Shanghai, China

    Shiwei Wang, Shaoli Han & Caixia Tian

  3. Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria

    Xiang Li

  4. Department of Urology, Qilu Hospital of Shandong University, No. 107, Cultural West Road, Jinan, 250012, China

    Benkang Shi

  5. Department of Radiology, Rizhao Hospital of Traditional Chinese Medicine, No. 35 Wanghai Road, Rizhao, 276800, China

    Shimin Zhao

  6. Department of Nuclear Medicine, Jinan Yaoying Medical Imaging Center, Jinan, 250012, China

    Pengfei Zhao

  7. Department of Nuclear Medicine, Beijing Chest Hospital, Beijing, China

    Xiang Li

Authors
  1. Yuekai Li
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  2. Shiwei Wang
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  3. Shimin Zhao
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  4. Pengfei Zhao
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  5. Shuai Huang
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  6. Kaiyue Li
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  7. Shaoli Han
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  8. Caixia Tian
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  9. Xin Li
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  10. Benkang Shi
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  11. Xiang Li
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Contributions

Yuekai Li: data analysis, draft writing; Shaoli Han, Shiwei Wang, and Caixia Tian: draft writing, machine learning analysis, Shuai Huang: radioactive tracer synthesis and quality control; Shimin Zhao and Pengfei Zhao: patient follow-up; Xiang Li, Benkang Shi, and Xin Li: methodology, writing—reviewing and editing. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Xin Li, Benkang Shi or Xiang Li.

Ethics declarations

Ethics approval

This study was reviewed and approved by the ethics committee of Qilu Hospital of Shandong University (KYLL-2017-573).

Consent to participate

Informed consents were obtained from all individual participants included in the study.

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Not applicable

Competing interests

The authors declare no competing interests.

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Li, Y., Wang, S., Zhao, S. et al. Initial [18F]DCFPyL PET/CT in treatment-naïve prostate cancer: correlation with post-ADT PSA outcomes and recurrence. Eur J Nucl Med Mol Imaging (2024). https://doi.org/10.1007/s00259-024-06684-z

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  • DOI: https://doi.org/10.1007/s00259-024-06684-z

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