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

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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
Surgical Pathology
Lymph Nodes
Molecular Imaging
Nuclear Medicine
Prostatectomy
Lymph Node Excision
Pelvis
Prostate
human glutamate carboxypeptidase II
2-(3-(1-carboxy-5-((6-fluoropyridine-3-carbonyl)amino)pentyl)ureido)pentanedioic acid

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 = "Michael Gorin and Steven Rowe and Patel, {Hiten D.} and Igor Vidal and Margarita Mana-ay and Javadi, {Mehrbod Som Som} and Lilja Solnes and Ross, {Ashley E.} and Schaeffer, {Edward M.} and Trinity Bivalacqua and Partin, {Alan Wayne} and Kenneth Pienta and Zsolt Szabo and Demarzo, {Angelo Michael} and Pomper, {Martin Gilbert} and Allaf, {Mohamad E}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.juro.2017.07.070",
language = "English (US)",
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

AU - Rowe, Steven

AU - Patel, Hiten D.

AU - Vidal, Igor

AU - Mana-ay, Margarita

AU - Javadi, Mehrbod Som Som

AU - Solnes, Lilja

AU - Ross, Ashley E.

AU - Schaeffer, Edward M.

AU - Bivalacqua, Trinity

AU - Partin, Alan Wayne

AU - Pienta, Kenneth

AU - Szabo, Zsolt

AU - Demarzo, Angelo Michael

AU - Pomper, Martin Gilbert

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

VL - 199

SP - 126

EP - 132

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 1

ER -