• M Wondergem, B H E Jansen, F M van der Zant, T M van der Sluis, Knol R J J RJJ Noordwest Ziekenhuisgroep, Nuclear Medicine, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands., L W M van Kalmthout, O S Hoekstra, van Moorselaar R J A RJA Amsterdam University Medical Centers, VU University, Urology, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands., D E Oprea-Lager, and A N Vis.
• Noordwest Ziekenhuisgroep, Nuclear Medicine, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands.
• Eur. J. Nucl. Med. Mol. Imaging. 2019 Aug 1; 46 (9): 1911-1918.

PurposeProstate-specific membrane antigen (PSMA) PET/CT is increasingly used in patients with biochemically recurrent prostate cancer (BCR), mostly using gallium-68 (168Ga)-labelled radiotracers. Alternatively, fluorine-18 (18F)-labelled PSMA tracers are available, such as 18F-DCFPyL, which offer enhanced image quality and therefore potentially increased detection of small metastases. In this study we evaluate the lesion detection efficacy of 18F-DCFPyL PET/CT in patients with BCR and determine the detection efficacy as a function of their PSA value.MethodsA total of 248 consecutive patients were evaluated and underwent scanning with 18F-DCFPyL PET/CT for BCR between November 2016 and 2018 in two hospitals in the Netherlands. Patients were examined after radical prostatectomy (52%), external-beam radiation therapy (42%) or brachytherapy (6%). Imaging was performed 120 min after injection of a median dose of 311 MBq 18F-DCFPyL.ResultsIn 214 out of 248 PET/CT scans (86.3%), at least one lesion suggestive of cancer recurrence was detected ('positive scan'). Scan positivity increased with higher PSA values: 17/29 scans (59%) with PSA values <0.5 ng/ml; 20/29 (69%) with PSA 0.5 to <1.0 ng/ml; 35/41 (85%) with PSA 1.0 to <2.0 ng/ml; 69/73 (95%) with PSA 2.0 to <5.0 ng/ml; and 73/76 (96%) with PSA ≥5.0 ng/ml. Interestingly, suspicious lesions outside the prostatic fossa were detected in 39-50% of patients with PSA <1.0 ng/ml after radical prostatectomy (i.e. candidates for salvage radiotherapy).Conclusion18F-DCFPyL PET/CT offers early detection of lesions in patients with BCR, even at PSA levels <0.5 ng/ml. These results appear to be comparable to those reported for 68Ga-PSMA and 18F-PSMA-1007, with potentially increased detection efficacy compared to 68Ga-PSMA for patients with PSA <2.0.

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