Nuclear Medicine Department, University General Hospital, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain.
Nuclear Medicine Department, Complejo Hospitalario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain.
Ann Nucl Med. 2023 Oct;37(10):551-560. doi: 10.1007/s12149-023-01859-4. Epub 2023 Aug 2.
To assess the diagnostic and therapeutic impact of PET/CT with 18F-DCFPyL with respect to 18F-Fluorocholine in initial staging of intermediate-/high-risk prostate cancer (PCa).
Patients with recent diagnosis of intermediate-/high-risk PCa without androgen deprivation therapy and previous 18F-Fluorocholine-PET/CT (negative for extraprostatic disease or with oligometastatic disease) were referred to 18F-DCFPyL-PET/CT. Patients' disease characteristic as grade group, D'Amico risk category (intermediate/high), prostate-specific antigen (PSA) closest to PET/CTs and its kinetics were obtained. The overall detection rate (DR) and molecular imaging TNM (miTNM) stage according to the prostate cancer molecular imaging standardized evaluation (PROMISE) criteria were assessed for both radiotracers, and their concordance (Kappa coefficient) was analyzed. The diagnostic and therapeutic impact of 18F-DCFPyL with respect to 18F-Fluorocholine was evaluated.
Fifty-eight patients were analyzed (84.5% high-risk). 18F-Fluorocholine showed a higher DR than 18F-DCFPyL of prostate gland involvement (100% versus 93.1%) and pelvic node disease (37.9% versus 31%; k = 0.436, p = 0.001). On the other hand, 18F-DCFPyL-PET/CT showed a higher DR of metastatic disease than 18F-Fluorocholine-PET/CT, 9/58 patients (15.5%): 3 M1a, 5 M1b and 1 M1c) versus 5/58 (8.6%) patients: 1 M1a and 4 M1b), k = 0.426; p = 0.001. No significant association was found between clinical characteristics (grade group, risk category, PSA level and kinetic) and 18F-Fluorocholine or 18F-DCFPyL results. The results of 18F-DCFPyL-PET/CT modified the previously planned treatment compared to 18F-Fluorocholine-PET/CT in 13 patients (22.4%).
18F-Fluorocholine and 18F-DCFPyL PET/CT showed a similar DR of prostate gland and lymph node involvement, although with moderate concordance for the latter. 18F-DCFPyL was superior to 18F-Fluorocholine in detecting regional and distant metastasis with a therapeutic impact in one of every five patients.
评估 18F-DCFPyL 与 18F-氟胆碱在中高危前列腺癌（PCa）初始分期中的诊断和治疗影响。
近期诊断为中高危 PCa 且未接受雄激素剥夺治疗且之前进行过 18F-氟胆碱-PET/CT（无前列腺外疾病或寡转移疾病）的患者被转诊至 18F-DCFPyL-PET/CT。获得患者疾病特征（分级组、D'Amico 风险类别[中高危]）、与 PET/CT 最接近的前列腺特异性抗原（PSA）及其动力学。根据前列腺癌分子成像标准化评估（PROMISE）标准，评估两种示踪剂的总检出率（DR）和分子成像 TNM（miTNM）分期，并分析其一致性（Kappa 系数）。评估 18F-DCFPyL 相对于 18F-氟胆碱的诊断和治疗影响。
分析了 58 名患者（84.5%为高危）。18F-氟胆碱显示出比 18F-DCFPyL 更高的前列腺受累 DR（100%对 93.1%）和盆腔淋巴结疾病（37.9%对 31%；k=0.436，p=0.001）。另一方面，18F-DCFPyL-PET/CT 比 18F-氟胆碱-PET/CT 显示出更高的转移性疾病 DR，58 名患者中有 9 名（15.5%）：3 名 M1a、5 名 M1b 和 1 名 M1c）与 58 名患者中的 5 名（8.6%）：1 名 M1a 和 4 名 M1b），k=0.426；p=0.001。18F-氟胆碱或 18F-DCFPyL 的结果与临床特征（分级组、风险类别、PSA 水平和动力学）之间无显著相关性。与 18F-氟胆碱-PET/CT 相比，18F-DCFPyL-PET/CT 改变了 13 名患者（22.4%）先前计划的治疗。
18F-氟胆碱和 18F-DCFPyL PET/CT 显示出相似的前列腺和淋巴结受累 DR，尽管后者的一致性为中等。与 18F-氟胆碱相比，18F-DCFPyL 在检测局部和远处转移方面更具优势，每五名患者中就有一名患者具有治疗影响。
