Utilization of Salvage and Systemic Therapies for Recurrent Prostate Cancer as a Result of 18F-DCFPyL PET/CT Restaging

Wei Liu, MD; Katherine Zukotynski, MD, PhD, FRCPC; Louise Emmett, MD, FRACP; Hans T. Chung, MD, FRCPC; Peter Chung, MD, FRCPC; Robert Wolfson, MD, FRCPC; Irina Rachinsky, MD, MSc, FRCPC; Anil Kapoor, MD, FRCSC; Ur Metser, MD, FRCPC; Andrew Loblaw, MD, MSc, FRCPC; Gerard Morton, MB, FRCPC; Tracy Sexton, MD, PhD, FRCPC; Michael Lock, MD, FRCPC; Joelle Helou, MD, MSc; Alejandro Berlin, MD, MSc; Colm Boylan, MB, FRCPC; Susan Archer, BSc; Gregory R. Pond, PhD, PStat; Glenn Bauman, MD, FRCPC

Advances in Radiation Oncology (Jan 2021)

Utilization of Salvage and Systemic Therapies for Recurrent Prostate Cancer as a Result of 18F-DCFPyL PET/CT Restaging

Wei Liu, MD,
Katherine Zukotynski, MD, PhD, FRCPC,
Louise Emmett, MD, FRACP,
Hans T. Chung, MD, FRCPC,
Peter Chung, MD, FRCPC,
Robert Wolfson, MD, FRCPC,
Irina Rachinsky, MD, MSc, FRCPC,
Anil Kapoor, MD, FRCSC,
Ur Metser, MD, FRCPC,
Andrew Loblaw, MD, MSc, FRCPC,
Gerard Morton, MB, FRCPC,
Tracy Sexton, MD, PhD, FRCPC,
Michael Lock, MD, FRCPC,
Joelle Helou, MD, MSc,
Alejandro Berlin, MD, MSc,
Colm Boylan, MB, FRCPC,
Susan Archer, BSc,
Gregory R. Pond, PhD, PStat,
Glenn Bauman, MD, FRCPC

Affiliations

Wei Liu, MD: Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
Katherine Zukotynski, MD, PhD, FRCPC: Departments of Medicine and Radiology, McMaster University, Hamilton, Canada
Louise Emmett, MD, FRACP: Department of Nuclear Medicine and Theranostics, St. Vincent’s Hospital and University of New South Wales, Sydney, Australia
Hans T. Chung, MD, FRCPC: Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
Peter Chung, MD, FRCPC: Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
Robert Wolfson, MD, FRCPC: Department of Medical Imaging, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
Irina Rachinsky, MD, MSc, FRCPC: Division of Nuclear Medicine, London Health Sciences Centre and Western University, London, Canada
Anil Kapoor, MD, FRCSC: Urologic Cancer Centre for Research & Innovation and McMaster University, Hamilton, Canada
Ur Metser, MD, FRCPC: Department of Medical Imaging, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
Andrew Loblaw, MD, MSc, FRCPC: Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Institute of Health Care Policy and Evaluation, University of Toronto, Canada
Gerard Morton, MB, FRCPC: Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
Tracy Sexton, MD, PhD, FRCPC: Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
Michael Lock, MD, FRCPC: Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
Joelle Helou, MD, MSc: Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
Alejandro Berlin, MD, MSc: Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Techna Institute, University Health Network, Toronto, Canada
Colm Boylan, MB, FRCPC: Department of Diagnostic Imaging, St. Joseph’s Healthcare and McMaster University, Hamilton, Canada
Susan Archer, BSc: Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
Gregory R. Pond, PhD, PStat: Department of Oncology, McMaster University, Hamilton, Canada
Glenn Bauman, MD, FRCPC: Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada; Corresponding author: Glenn Bauman, MD, FRCPC

Journal volume & issue: Vol. 6, no. 1
p. 100553

Abstract

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Purpose: Our purpose was to investigate the effect of the addition of prostate-specific membrane antigen (PSMA)-targeted positron emission tomography/computed tomography (PET/CT) in patients with recurrent prostate cancer post-primary radiation therapy. Methods and Materials: A prospective, multi-institutional clinical trial evaluated 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) PET/CT restaging in 79 men with recurrent prostate cancer post-primary radiation therapy. We report actual patient management and compare this with proposed management both before and after PSMA-targeted PET/CT. Results: Most patients (59%) had a major change in actual management compared with pre-PET/CT proposed management. The rate of major change was underestimated by immediately post-PET/CT surveys (32%). Eighteen patients with PSMA avidity in the prostate gland suspicious for malignancy had a prostate biopsy. Sensitivity, specificity, and positive predictive values of PSMA uptake in the prostate were 86%, 67%, and 92%, respectively. Thirty percent of patients had directed salvage therapy and 41% underwent systemic therapy. Eleven out of 79 patients (14%) had high-dose-rate brachytherapy alone for local recurrence, and 91% were free of recurrence at a median follow-up of 20 months. Conclusions: Most patients had a major change in actual management compared with pre–PSMA-targeted PET/CT planned management, and this was underestimated by post-PET/CT questionnaires.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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