Prostate Specific Membrane Antigen Targeted 18F-DCFPyL Positron Emission Tomography/Computerized Tomography for the Preoperative Staging of High Risk Prostate Cancer: Results of a Prospective, Phase II, Single Center Study

Michael A. Gorin, Steven P. Rowe, Hiten D. Patel, Igor Vidal, Margarita Mana-ay, Mehrbod S. Javadi, Lilja B. Solnes, Ashley E. Ross, Edward M. Schaeffer, Trinity J. Bivalacqua, Alan W. Partin, Kenneth J. Pienta, Zsolt Szabo, Angelo M. De Marzo, Martin G. Pomper, Mohamad E. Allaf

Research output: Research - peer-reviewArticle

Abstract

Purpose We prospectively evaluated the diagnostic performance of prostate specific membrane antigen targeted 18F-DCFPyL positron emission tomography/computerized tomography in the preoperative staging of men at high risk for harboring metastatic prostate cancer despite a negative conventional staging evaluation. Materials and Methods Men with clinically localized high or very high risk prostate cancer were imaged with 18F-DCFPyL positron emission tomography/computerized tomography before undergoing radical prostatectomy with standardized pelvic lymph node dissection. The scans were interpreted by 2 blinded nuclear medicine readers and assessed for interreader variability as well as diagnostic accuracy for pelvic lymph node staging. Surgical pathology served as the reference standard to which 18F-DCFPyL scan findings were compared. Results A total of 25 men contributed analyzable data to this study. Seven of these patients (28%) were found to have 1 or more positive lymph nodes on surgical pathology. Sites of radiotracer uptake were identified in the prostate of all imaged patients. The 2 readers identified the same number of prostatic lesions in 22 patients (88%), of whom all had at least 1 intraprostatic lesion in common between the 2 reads. Additionally, the readers assigned the same N stage to 46 of 50 individual lymph node packets (92%). Following reconciliation of the relatively few discordant imaging reads, 7 patients (28%) were found to have 1 or more sites of radiotracer uptake in the pelvis consistent with N1 disease, resulting in 71.4% sensitivity (95% CI 29.0–96.3) and 88.9% specificity (95% CI 65.3–98.6). Analysis at the level of individual nodal packets resulted in 66.7% sensitivity (95% CI 29.9–92.5) and 92.7% specificity (95% CI 80.1–98.5). Three men (12%) had evidence of M1a disease. Conclusions 18F-DCFPyL positron emission tomography/computerized tomography allowed for accurate detection of prostate cancer sites in men believed to have clinically localized disease based on conventional imaging. Our results support the need for a larger study to more precisely define the diagnostic accuracy of this novel molecular imaging test.

LanguageEnglish (US)
Pages126-132
Number of pages7
JournalJournal of Urology
Volume199
Issue number1
DOIs
StatePublished - Jan 1 2018

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Positron-Emission Tomography
Prostatic Neoplasms
Tomography
human glutamate carboxypeptidase II
Lymph Nodes
Surgical Pathology
Molecular Imaging
Nuclear Medicine
Prostatectomy
Lymph Node Excision
Pelvis
Prostate

Keywords

  • 2-(3-(1-carboxy-5-((6-fluoropyridine-3-carbonyl)amino)pentyl)ureido)pentanedioic acid
  • diagnosis
  • positron-emission tomography
  • prostatic neoplasms
  • tomography
  • X-ray computed

ASJC Scopus subject areas

  • Urology

Cite this

@article{27cad417cbe14d1fb351c9714888e84d,
title = "Prostate Specific Membrane Antigen Targeted 18F-DCFPyL Positron Emission Tomography/Computerized Tomography for the Preoperative Staging of High Risk Prostate Cancer: Results of a Prospective, Phase II, Single Center Study",
abstract = "Purpose We prospectively evaluated the diagnostic performance of prostate specific membrane antigen targeted 18F-DCFPyL positron emission tomography/computerized tomography in the preoperative staging of men at high risk for harboring metastatic prostate cancer despite a negative conventional staging evaluation. Materials and Methods Men with clinically localized high or very high risk prostate cancer were imaged with 18F-DCFPyL positron emission tomography/computerized tomography before undergoing radical prostatectomy with standardized pelvic lymph node dissection. The scans were interpreted by 2 blinded nuclear medicine readers and assessed for interreader variability as well as diagnostic accuracy for pelvic lymph node staging. Surgical pathology served as the reference standard to which 18F-DCFPyL scan findings were compared. Results A total of 25 men contributed analyzable data to this study. Seven of these patients (28%) were found to have 1 or more positive lymph nodes on surgical pathology. Sites of radiotracer uptake were identified in the prostate of all imaged patients. The 2 readers identified the same number of prostatic lesions in 22 patients (88%), of whom all had at least 1 intraprostatic lesion in common between the 2 reads. Additionally, the readers assigned the same N stage to 46 of 50 individual lymph node packets (92%). Following reconciliation of the relatively few discordant imaging reads, 7 patients (28%) were found to have 1 or more sites of radiotracer uptake in the pelvis consistent with N1 disease, resulting in 71.4% sensitivity (95% CI 29.0–96.3) and 88.9% specificity (95% CI 65.3–98.6). Analysis at the level of individual nodal packets resulted in 66.7% sensitivity (95% CI 29.9–92.5) and 92.7% specificity (95% CI 80.1–98.5). Three men (12%) had evidence of M1a disease. Conclusions 18F-DCFPyL positron emission tomography/computerized tomography allowed for accurate detection of prostate cancer sites in men believed to have clinically localized disease based on conventional imaging. Our results support the need for a larger study to more precisely define the diagnostic accuracy of this novel molecular imaging test.",
keywords = "2-(3-(1-carboxy-5-((6-fluoropyridine-3-carbonyl)amino)pentyl)ureido)pentanedioic acid, diagnosis, positron-emission tomography, prostatic neoplasms, tomography, X-ray computed",
author = "Gorin, {Michael A.} and Rowe, {Steven P.} and Patel, {Hiten D.} and Igor Vidal and Margarita Mana-ay and Javadi, {Mehrbod S.} and Solnes, {Lilja B.} and Ross, {Ashley E.} and Schaeffer, {Edward M.} and Bivalacqua, {Trinity J.} and Partin, {Alan W.} and Pienta, {Kenneth J.} and Zsolt Szabo and {De Marzo}, {Angelo M.} and Pomper, {Martin G.} and Allaf, {Mohamad E.}",
year = "2018",
month = "1",
doi = "10.1016/j.juro.2017.07.070",
volume = "199",
pages = "126--132",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Prostate Specific Membrane Antigen Targeted 18F-DCFPyL Positron Emission Tomography/Computerized Tomography for the Preoperative Staging of High Risk Prostate Cancer

T2 - Journal of Urology

AU - Gorin,Michael A.

AU - Rowe,Steven P.

AU - Patel,Hiten D.

AU - Vidal,Igor

AU - Mana-ay,Margarita

AU - Javadi,Mehrbod S.

AU - Solnes,Lilja B.

AU - Ross,Ashley E.

AU - Schaeffer,Edward M.

AU - Bivalacqua,Trinity J.

AU - Partin,Alan W.

AU - Pienta,Kenneth J.

AU - Szabo,Zsolt

AU - De Marzo,Angelo M.

AU - Pomper,Martin G.

AU - Allaf,Mohamad E.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose We prospectively evaluated the diagnostic performance of prostate specific membrane antigen targeted 18F-DCFPyL positron emission tomography/computerized tomography in the preoperative staging of men at high risk for harboring metastatic prostate cancer despite a negative conventional staging evaluation. Materials and Methods Men with clinically localized high or very high risk prostate cancer were imaged with 18F-DCFPyL positron emission tomography/computerized tomography before undergoing radical prostatectomy with standardized pelvic lymph node dissection. The scans were interpreted by 2 blinded nuclear medicine readers and assessed for interreader variability as well as diagnostic accuracy for pelvic lymph node staging. Surgical pathology served as the reference standard to which 18F-DCFPyL scan findings were compared. Results A total of 25 men contributed analyzable data to this study. Seven of these patients (28%) were found to have 1 or more positive lymph nodes on surgical pathology. Sites of radiotracer uptake were identified in the prostate of all imaged patients. The 2 readers identified the same number of prostatic lesions in 22 patients (88%), of whom all had at least 1 intraprostatic lesion in common between the 2 reads. Additionally, the readers assigned the same N stage to 46 of 50 individual lymph node packets (92%). Following reconciliation of the relatively few discordant imaging reads, 7 patients (28%) were found to have 1 or more sites of radiotracer uptake in the pelvis consistent with N1 disease, resulting in 71.4% sensitivity (95% CI 29.0–96.3) and 88.9% specificity (95% CI 65.3–98.6). Analysis at the level of individual nodal packets resulted in 66.7% sensitivity (95% CI 29.9–92.5) and 92.7% specificity (95% CI 80.1–98.5). Three men (12%) had evidence of M1a disease. Conclusions 18F-DCFPyL positron emission tomography/computerized tomography allowed for accurate detection of prostate cancer sites in men believed to have clinically localized disease based on conventional imaging. Our results support the need for a larger study to more precisely define the diagnostic accuracy of this novel molecular imaging test.

AB - Purpose We prospectively evaluated the diagnostic performance of prostate specific membrane antigen targeted 18F-DCFPyL positron emission tomography/computerized tomography in the preoperative staging of men at high risk for harboring metastatic prostate cancer despite a negative conventional staging evaluation. Materials and Methods Men with clinically localized high or very high risk prostate cancer were imaged with 18F-DCFPyL positron emission tomography/computerized tomography before undergoing radical prostatectomy with standardized pelvic lymph node dissection. The scans were interpreted by 2 blinded nuclear medicine readers and assessed for interreader variability as well as diagnostic accuracy for pelvic lymph node staging. Surgical pathology served as the reference standard to which 18F-DCFPyL scan findings were compared. Results A total of 25 men contributed analyzable data to this study. Seven of these patients (28%) were found to have 1 or more positive lymph nodes on surgical pathology. Sites of radiotracer uptake were identified in the prostate of all imaged patients. The 2 readers identified the same number of prostatic lesions in 22 patients (88%), of whom all had at least 1 intraprostatic lesion in common between the 2 reads. Additionally, the readers assigned the same N stage to 46 of 50 individual lymph node packets (92%). Following reconciliation of the relatively few discordant imaging reads, 7 patients (28%) were found to have 1 or more sites of radiotracer uptake in the pelvis consistent with N1 disease, resulting in 71.4% sensitivity (95% CI 29.0–96.3) and 88.9% specificity (95% CI 65.3–98.6). Analysis at the level of individual nodal packets resulted in 66.7% sensitivity (95% CI 29.9–92.5) and 92.7% specificity (95% CI 80.1–98.5). Three men (12%) had evidence of M1a disease. Conclusions 18F-DCFPyL positron emission tomography/computerized tomography allowed for accurate detection of prostate cancer sites in men believed to have clinically localized disease based on conventional imaging. Our results support the need for a larger study to more precisely define the diagnostic accuracy of this novel molecular imaging test.

KW - 2-(3-(1-carboxy-5-((6-fluoropyridine-3-carbonyl)amino)pentyl)ureido)pentanedioic acid

KW - diagnosis

KW - positron-emission tomography

KW - prostatic neoplasms

KW - tomography

KW - X-ray computed

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U2 - 10.1016/j.juro.2017.07.070

DO - 10.1016/j.juro.2017.07.070

M3 - Article

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JO - Journal of Urology

JF - Journal of Urology

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IS - 1

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