[18F]DCFPyL PET/CT in Detection and Localization of Recurrent Prostate Cancer Following Prostatectomy Including Low PSA  0.5 ng/mL - Beyond the Abstract

The aim of this retrospective multicenter analysis was to assess the performance of [18F]DCFPyL prostate-specific membrane antigen (PSMA) PET/CT in the detection and localization of recurrent prostate cancer following radical prostatectomy (RP). Although the use of PSMA PET/CT in biochemical failure post-prostatectomy has been validated by international literature as being superior to conventional imaging1,2 and having a significant impact on management,2-8 the recommendation for its use in prostate cancer guidelines is heterogeneous and therefore public funding for this investigative pathway is limited.9-13 Specifically, PSMA PET/CT is not publicly funded for this indication in Australia and is only publicly available in one region of New Zealand but only when prostate-specific antigen (PSA) is above 0.5ng/mL. Conversely, PSMA PET/CT is widely available for those with insurance although some providers only approve above a PSA threshold. Given prostate cancer is the most commonly diagnosed cancer and is the second-highest cause of all cancer deaths in Australia, lack of access to PSMA PET/CT may adversely affect the outcome in these patients.14,15 Particular reference is given to low PSA groups < 0.5 ng/mL in our study to aid discussion around the inclusion of this group in international guidelines and funding pathways.


Our study is the largest to date examining [18F]DCFPyL PET/CT in biochemical failure with particular reference to patients with PSA < 0.5 ng/mL. We included 222 patients with biochemical failure who underwent [18F]DCFPyL PET/CT at two sites in Australia and New Zealand. 46.4% (103/222) of these patients had PSA <0.5ng/mL. Within this group, we found a significant number had disease beyond the prostate bed, either with involved pelvic nodes (23.3%) or extra pelvic disease (13.6%) [Figure 1].

Distribution of individual lesions with increased PSMA expression

Figure 1. Distribution of individual lesions with increased PSMA expression for patients with PSA < 0.5ng/mL.

The incidence of pelvic nodal and extra pelvic metastases increased with PSA level. The number of positive PSMA studies, however, was similar in the <0.5ng/mL group (59.2%) and the 0.5-0.99ng/mL group (62.8%) [Table 1].

Table 1. Site of disease recurrence stratified by PSA group 

Site of disease recurrence stratified by PSA group

Our data suggests that recurrent prostate cancer is frequently detectable by [18F]DCFPyL PET/CT even in low PSA groups. Our results are similar to studies using 68Ga PSMA and to other studies using [18F]DCFPyL PET/CT but with smaller numbers.4,16-20

We would recommend validating these findings with a prospective study that aims to examine the impact on management decisions in this cohort. In this regard, we await data from the current IMPPORT trial.21 Future directions may involve assessment of any incremental value of PET/MRI imaging in those with biochemical failure with recent data suggesting increased detection rate of local recurrence at low PSA levels using this modality and follow-up of  [18F]DCFPyL staged patients receiving salvage radiotherapy.22

Written by: Elisa Perry, Arpit Talwar, Kim Taubman, Michael Ng, Lih-Ming Wong, Russell Booth, Tom R Sutherland

Pacific Radiology, Christchurch, Canterbury, New Zealand., Department of Medical Imaging, St. Vincent's Hospital, Melbourne, Victoria, Australia., GenesisCare, St. Vincent's Hospital, Melbourne, Victoria, Australia., Department of Urology, St. Vincent's Hospital, Melbourne, Victoria, Australia.

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