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Detection of clinically significant prostate cancer with 18F-DCFPyL PET/multiparametric MR

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To assess whether 18F-DCFPyL PET/multiparametric (mp)MR contributes to the diagnosis of clinically significant (cs) prostate cancer (PCa) compared to mpMR in patients with suspicion of PCa, or patients being considered for focal ablative therapies (FT).

Patients and methods

This ethics review board–approved, prospective study included 55 men with suspicion of PCa and negative systematic biopsies or clinically discordant low-risk PCa (n = 21) or those being considered for FT (n = 34) who received 18F-DCFPyL PET/mpMR. Each modality, PET, mpMR, and PET/MR (using the PROMISE classification), was assessed independently. All suspicious lesions underwent PET/MR-ultrasound fusion biopsies.

Results

There were 45/55 patients (81.8%) that had histologically proven PCa and 41/55 (74.5%) were diagnosed with csPCa. Overall, 61/114 lesions (53.5%) identified on any modality were malignant; 49/61 lesions (80.3%) were csPCa. On lesion-level analysis, for detection of csPCa, the sensitivity of PET was higher than that of mpMR and PET/MR (86% vs 67% and 69% [p = 0.027 and 0.041, respectively]), but at a lower specificity (32% vs 85% and 86%, respectively [p < 0.001]). The performance of MR and PET/MR was comparable. For identification of csPCa in PI-RADS ≥ 3 lesions, the AUC (95% CI) for PET, mpMR, and PET/MR was 0.75 (0.65–0.86), 0.69 (0.56–0.82), and 0.78 (0.67–0.89), respectively. The AUC for PET/MR was significantly larger than that of mpMR (p = 0.04).

Conclusion

PSMA PET detects more csPCa than mpMR, but at low specificity. The performance PET/MR is better than mpMR for detection of csPCa in PI-RADS ≥ 3 lesions.

Clinical registration

NCT 03149861

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Acknowledgements

The authors would like to acknowledge Linda Chan and Miho Horie, study coordinators, for their dedicated work on this trial.

Funding

Mount Sinai Hospital-University Health Network Academic Medical Organization Innovation Fund 2017–2019; Toronto, ON, Canada.

Author information

Authors and Affiliations

  1. Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women’s College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada

    Ur Metser, Claudia Ortega, Eli Lechtman, Reut Anconina, Yael Eshet, Rosanna Chan, Patrick Veit-Haibach & Sangeet Ghai

  2. Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada

    Nathan Perlis

  3. Department of Radiation Oncology, Princess Margaret Cancer Center, University Health Network & University of Toronto, Toronto, ON, Canada

    Alejandro Berlin

  4. Laboratory Medicine Program, University Health Network, Toronto, ON, Canada

    Theodorus H. van der Kwast

  5. Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada

    Amy Liu

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Corresponding author

Correspondence to Ur Metser.

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Ethics approval and consent to participate

Institutional review board approved including written informed consent from all study participants.

Conflict of interest

Ur Metser is a consultant for POINT Biopharma Inc. (unrelated to study); no other relevant financial or non-financial interests to disclose.

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This article is part of the Topical Collection on Oncology - Genitourinary

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Metser, U., Ortega, C., Perlis, N. et al. Detection of clinically significant prostate cancer with 18F-DCFPyL PET/multiparametric MR. Eur J Nucl Med Mol Imaging 48, 3702–3711 (2021). https://doi.org/10.1007/s00259-021-05355-7

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  • DOI: https://doi.org/10.1007/s00259-021-05355-7

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