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Pd38-05 Clinical Utility of Preoperative Psma-targeted 18 F-dcfpyl Pet/ct in Men With High-risk Prostate Cancer: Diagnostic Performance Comparisons With Pelvic Ct or Mri in the Osprey Prospective, Multi-center Trial

Year: 2020

Type: article

Abstract: You have accessJournal of UrologyProstate Cancer: Detection & Screening III (PD38)1 Apr 2020PD38-05 CLINICAL UTILITY OF PREOPERATIVE PSMA-TARGETED 18F-DCFPYL PET/CT IN MEN WITH HIGH-RISK PROSTATE CANCER: DIAGNOSTIC PERFORMANCE COMPARISONS WITH PELVIC CT OR MRI IN THE OSPREY PROSPECTIVE, MULTI-CENTER TRIAL Preston Sprenkle*, Peter Carroll, Stephan Probst, Michael A. Gorin, Steven P. Rowe, Kenneth J. Pienta, Frédéric Pouliot, Akash Patnaik, Mark A. Preston, Ajjai Alva, Barry A. Siegel, and Michael J. Morris Preston Sprenkle*Preston Sprenkle* More articles by this author , Peter CarrollPeter Carroll More articles by this author , Stephan ProbstStephan Probst More articles by this author , Michael A. GorinMichael A. Gorin More articles by this author , Steven P. RoweSteven P. Rowe More articles by this author , Kenneth J. PientaKenneth J. Pienta More articles by this author , Frédéric PouliotFrédéric Pouliot More articles by this author , Akash PatnaikAkash Patnaik More articles by this author , Mark A. PrestonMark A. Preston More articles by this author , Ajjai AlvaAjjai Alva More articles by this author , Barry A. SiegelBarry A. Siegel More articles by this author , and Michael J. MorrisMichael J. Morris More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000917.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current imaging modalities are suboptimal for the initial staging of men at risk of harboring occult metastatic prostate cancer (PCa) because of the low positive and negative predictive values (PPV and NPV) of pelvic CT/MRI for detecting regional nodal metastases (N1). Prostate-specific membrane antigen (PSMA) is overexpressed by PCa cells and PSMA-based PET has demonstrated high PPV and NPV for identifying regional and distant metastases. 18F-DCFPyL is a novel PSMA-targeted PET radiopharmaceutical that may improve the accuracy of staging high-risk patients to guide initial therapy planning. METHODS: 18F-DCFPyL PET/CT was evaluated in 252 men with high-risk PCa due to undergo radical prostatectomy with pelvic lymphadenectomy (RP-PLND). ∼9 mCi (333 MBq) of 18F-DCFPyL was administered 1-2 hours prior to PET/CT. Sensitivity, specificity, PPV and NPV of 18F-DCFPyL PET/CT for detecting primary tumor in the gland and pelvic lymph node metastases were compared to conventional imaging (CI), either CT or MRI. Three central, blinded, and independent readers evaluated the 18F-DCFPyL scans and one blinded central reader interpreted the CI. Imaging results were compared to surgical pathology as the truth standard. RESULTS: The diagnostic performance characteristics of 18F-DCFPyL PET/CT and CI for determining PCa in the gland and pelvic lymph node are shown in Table 1. Despite similar sensitivity (40.3% for 18F-DCFPyL PET/CT and 41.7% for CI) in detecting N1 disease, the PPV of 18F-DCFPyL PET/CT (86.7%) was nearly 3-fold higher than CI (29.1%) in identifying true pelvic lymph node metastases. 18F-DCFPyL-PET/CT was more specific than CI (97.9% vs. 67.3%) and has a higher NPV than CI (83.2% vs. 78.3%). 18F-DCFPyL-PET/CT was also more sensitive in detecting primary tumor in the prostate gland, with sensitivity of 98% for PyL and 36% for CI). CONCLUSIONS: When compared to pelvic CT or MRI for determining prostate gland and pelvic lymph node disease, using histopathology as the truth standard, the diagnostic performance of 18F-DCFPyL PET/CT was superior in identifying the true extent of disease and could guide initial therapy in pts with high-risk PCa. NCT02981368. Source of Funding: Progenics Pharmaceuticals, Inc. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e802-e803 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Preston Sprenkle* More articles by this author Peter Carroll More articles by this author Stephan Probst More articles by this author Michael A. Gorin More articles by this author Steven P. Rowe More articles by this author Kenneth J. Pienta More articles by this author Frédéric Pouliot More articles by this author Akash Patnaik More articles by this author Mark A. Preston More articles by this author Ajjai Alva More articles by this author Barry A. Siegel More articles by this author Michael J. Morris More articles by this author Expand All Advertisement PDF downloadLoading ...

Source: The Journal of Urology

DOI: 10.1097/ju.0000000000000917.05