Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., E.M., L.L., P.L.C., B.T.); Center of Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., B.J.W.).
Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (K.H.L., E.M., L.L., P.L.C., B.T.).
Acad Radiol. 2024 Apr;31(4):1419-1428. doi: 10.1016/j.acra.2023.09.002. Epub 2023 Sep 27.
To analyze variables that can predict the positivity of F-DCFPyL- positron emission tomography/computed tomography (PET/CT) and extent of disease in patients with biochemically recurrent (BCR) prostate cancer after primary local therapy with either radical prostatectomy or radiation therapy.
This is a retrospective analysis of a prospective single institutional review board-approved study. We included 199 patients with biochemical recurrence and negative conventional imaging after primary local therapies (radical prostatectomy n = 127, radiation therapy n = 72). All patients underwent F-DCFPyL-PET/CT. Univariate and multivariate logistic regression analyses were used to determine predictors of a positive scan for both cohort of patients. Regression-based coefficients were used to develop nomograms predicting scan positivity and extra-pelvic disease. Decision curve analysis (DCA) was implemented to quantify nomogram's clinical benefit.
Of the 127 (63%) post-radical prostatectomy patients, 91 patients had positive scans - 61 of those with intrapelvic lesions and 30 with extra-pelvic lesions (i.e., retroperitoneal or distant nodes and/or bone/organ lesions). Of the 72 post-radiation therapy patients, 65 patients had positive scans - 39 of them had intrapelvic lesions and 26 extra-pelvic lesions. In the radical prostatectomy cohort, multivariate regression analysis revealed original International Society of Urological Pathology category, prostate-specific antigen (PSA), prostate-specific antigen doubling time (PSAdt), and time from BCR (mo) to scan were predictors for scan positivity and presence of extra-pelvic disease, with an area under the curve of 80% and 78%, respectively. Positive versus negative tumor margin after radical prostatectomy was not related to scan positivity or to the presence of positive extra-pelvic foci. In the radiation therapy cohort, multivariate regression analysis revealed that PSA, PSAdt, and time to BCR (mo) were predictors of extra-pelvic disease, with area under the curve of 82%. Because only seven patients in the radiation therapy cohort had negative scans, a prediction model for scan positivity could not be analyzed and only the presence of extra-pelvic disease was evaluated.
PSA and PSAdt are consistently significant predictors of F-DCFPyL PET/CT positivity and extra-pelvic disease in BCR prostate cancer patients. Stratifying the patient population into primary local treatment group enables the use of other variables as predictors, such as time since BCR. This nomogram may guide selection of the most suitable candidates for F-DCFPyL-PET/CT imaging.
分析变量以预测原发局部治疗（根治性前列腺切除术或放疗）后生化复发（BCR）前列腺癌患者 F-DCFPyL-正电子发射断层扫描/计算机断层扫描（PET/CT）的阳性率和疾病程度。
这是一项对前瞻性单机构审查委员会批准的研究进行的回顾性分析。我们纳入了 199 例原发性局部治疗后生化复发且常规影像学检查阴性的患者（根治性前列腺切除术 n=127，放疗 n=72）。所有患者均行 F-DCFPyL-PET/CT 检查。对两组患者的阳性扫描进行单因素和多因素逻辑回归分析，以确定预测因素。基于回归的系数用于开发预测扫描阳性和盆腔外疾病的列线图。实施决策曲线分析（DCA）以量化列线图的临床获益。
在 127 例（63%）根治性前列腺切除术患者中，91 例患者的扫描结果为阳性-其中 61 例为盆腔内病变，30 例为盆腔外病变（即腹膜后或远处淋巴结和/或骨骼/器官病变）。在 72 例放疗患者中，65 例患者的扫描结果为阳性-其中 39 例为盆腔内病变，26 例为盆腔外病变。在根治性前列腺切除术队列中，多因素回归分析显示，国际泌尿病理学会（ISUP）分类、前列腺特异性抗原（PSA）、PSA 倍增时间（PSAdt）和从 BCR 到扫描的时间（mo）是预测扫描阳性和存在盆腔外疾病的因素，曲线下面积分别为 80%和 78%。根治性前列腺切除术后肿瘤切缘阳性与扫描阳性或阳性盆腔外病灶无关。在放疗队列中，多因素回归分析显示，PSA、PSAdt 和 BCR 时间（mo）是盆腔外疾病的预测因素，曲线下面积为 82%。由于放疗队列中只有 7 例患者的扫描结果为阴性，因此无法分析扫描阳性的预测模型，只能评估盆腔外疾病的存在。
PSA 和 PSAdt 是预测 BCR 前列腺癌患者 F-DCFPyL-PET/CT 阳性和盆腔外疾病的一致重要预测因素。对患者人群进行原发局部治疗分组，可使用其他变量作为预测因素，如从 BCR 开始的时间。该列线图可能有助于指导选择最适合 F-DCFPyL-PET/CT 成像的患者。
