Amorelli Francesco, Foro Palmira, Blanco Juan Sebastian, Ocanto Abrahams, Natali Augusto, Fumado Lluis, Plaza Pedro
Department of Radiation Oncology, Hospital Del Mar, 08003 Barcelona, Spain.
PhD Program, Doctoral School, Pompeu Fabra University, 08002 Barcelona, Spain.
Cancers (Basel). 2025 Apr 9;17(8):1272. doi: 10.3390/cancers17081272.
Biochemical recurrence (BCR) occurs in 20-50% of patients with localized prostate cancer (PC) after radical prostatectomy (RP). Conventional imaging often fails to detect early local or systemic recurrences at low PSA levels. Positron emission tomography/computed tomography (PET/CT) with 18F-DCFPyL PSMA offers improved sensitivity and specificity for detecting recurrent disease. This study evaluates the diagnostic capability of 18F-DCFPyL PET/CT in early BCR of PC following RP and its impact on therapeutic decision-making and clinical management.
In a prospective study, 85 patients with BCR (PSA 0.2-2.0 ng/mL) and negative conventional imaging underwent 18F-DCFPyL PET/CT. Detection rates (DRs) were analyzed against clinical variables, including PSA levels and PSA doubling time (DT-PSA). Lesions were classified into local recurrence, lymph node involvement, bone, and visceral disease. Therapeutic decisions were adjusted based on PET/CT findings.
18F-DCFPyL PET/CT identified lesions in 53% of patients, with DRs of 31.3%, 60%, and 77.8% for PSA levels <0.5, 0.5-1, and >1 ng/mL, respectively. DRs were significantly associated with shorter DT-PSAs (<6 months: 61.5%). The lesions detected included 22.2% local recurrences, 51.1% lymph node disease, 20% bone, and 6.7% visceral involvement. ROC analysis determined optimal PSA and DT-PSA cutoffs of 0.55 ng/mL and 9.2 months, respectively. Therapeutic strategies were modified in 84.4% of PET-positive cases.
18F-DCFPyL PET/CT demonstrates high sensitivity for detecting recurrent PC at low PSA levels, significantly impacting therapeutic decisions and optimizing clinical management. These findings support its integration into guidelines for managing early BCR of PC.
在接受根治性前列腺切除术（RP）的局限性前列腺癌（PC）患者中，20%-50%会发生生化复发（BCR）。传统成像在低PSA水平时往往无法检测到早期局部或全身复发。18F-DCFPyL PSMA正电子发射断层扫描/计算机断层扫描（PET/CT）在检测复发性疾病方面具有更高的灵敏度和特异性。本研究评估了18F-DCFPyL PET/CT在RP术后PC早期BCR中的诊断能力及其对治疗决策和临床管理的影响。
在一项前瞻性研究中，85例BCR（PSA 0.2-2.0 ng/mL）且传统成像阴性的患者接受了18F-DCFPyL PET/CT检查。根据包括PSA水平和PSA倍增时间（DT-PSA）在内的临床变量分析检出率（DRs）。病变分为局部复发、淋巴结受累、骨和内脏疾病。根据PET/CT结果调整治疗决策。
18F-DCFPyL PET/CT在53%的患者中发现了病变，PSA水平<0.5、0.5-1和>1 ng/mL时的DRs分别为31.3%、60%和77.8%。DRs与较短的DT-PSA（<6个月：61.5%）显著相关。检测到的病变包括22.2%的局部复发、51.1%的淋巴结疾病、20%的骨和6.7%的内脏受累。ROC分析确定最佳PSA和DT-PSA临界值分别为0.55 ng/mL和9.2个月。84.4%的PET阳性病例修改了治疗策略。
18F-DCFPyL PET/CT在低PSA水平下检测复发性PC具有高灵敏度，对治疗决策有显著影响并优化了临床管理。这些发现支持将其纳入PC早期BCR管理指南。
