PSMA-directed radiotracer locates metastatic prostate cancer in anatomical regions

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Case example: A 54-year-old man with a history of RP + LND and a subsequent PSA of 1.25 ng / ml had no evidence of disease by baseline imaging. Piflufolastat F 18 (18F-DCFPyL) – PET / CT accurately detected a biochemically recurrent prostate cancer with PSMA PET / CT that identifies the left (left panel) and right (right panel) peri-rectal lymph nodes. Credit: Lantheus Holdings, Inc., Billerica, MA.

A phase III clinical trial has validated the efficacy of the 18F-DCFPyL radiotracer targeted to prostate-specific membrane antigen (PSMA) to detect and locate recurrent prostate cancer. Approved by the U.S. Food and Drug Administration last month, the radiotracer identified metastatic lesions with high positive predictive values ​​regardless of the anatomical region, adding to the evidence that PSMA-targeted radiotracers are the most common agents. sensitive and accurate for the image of prostate cancer. This study was presented at the 2021 annual meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI).

Prostate cancer patients have high levels of PSMA expression, making PSMA an effective target for disease imaging. In previous studies, the new positron emission tomography (PET) imaging agent 18F-DCFPyL was found to bind selectively with high affinity to PSMA. To demonstrate the diagnostic performance of 18F-DCFPyL for regulatory approval, a multicenter prospective study was conducted at 14 sites in the United States and Canada.

The study attempted to determine the (the likelihood that patients with a positive screening test will actually have the disease) and the detection rate of 18F-DCFPyL PET / computed tomography (CT) by anatomical region, specifically the prostate / prostate bed, pelvic lymph nodes, and the regions outside the pelvis. Study participants included men who had increasing levels of prostate-specific antigen (PSA) after local therapy, as well as negative or equivocal conventional imaging results.

Patients were imaged with 18F-DCFPyL PET / CT, and then reimagined after 60 days to verify suspicious lesions using a composite “truth standard,” which consisted of histopathology, correlative imaging findings, and PSA response. . By comparing the findings between the 18F-DCFPyL image and the “truth standard,” the positive predictive value and detection rate were measured.

18F-DCFPyL-PET / CT was found to successfully detect and locate metastatic lesions with a high positive predictive value, regardless of their location in the body, in men with biochemical recurrences. which had negative or equivocal basal images. Higher positive predictive values ​​were observed in lymph nodes and extra-pelvic bones compared to soft tissue regions.

With the recent approval of 18F-DCFPyL (now known as F-18 piflufolastat) by the FDA, the impact of this research may occur in the very near future. As these agents become more available, patients are newly diagnosed, recurrent, and metastatic cancer may have new therapeutic approaches at its disposal. The results of the study will be presented at the SNMMI meeting by Steven Rowe, MD, Ph.D., associate professor of radiology and radiological sciences at Johns Hopkins University in Baltimore, Maryland.


In recurrent prostate cancer, management of PSMA PET / CT changes in two-thirds of cases


More information:
Summary 123. “A Phase 3 Study of 18F-DCFPyL-PET / CT in Patients with Biochemically Recurrent Prostate Cancer (CONDOR): Analysis of Disease Detection Rate and Positive Predictive Value (PPV) by Anatomical Region”

Provided by the Society of Nuclear Medicine and Molecular Imaging

Citation: PSMA-led radiotracer locates metastatic prostate cancer in all anatomical regions (2021, June 15) retrieved June 16, 2021 from https://medicalxpress.com/news/2021-06-psma-targeted- radiotracer-metastatic-prostate-cancer.html

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