Clinical Factors Associated with Suspicious 18 F-DCFPyL PSMA PET Activity in Patients Initially Managed with Radical Prostatectomy including PSA <0.5 ng/mL

No AccessJournal of UrologyOriginal Clinical Article18 Oct 2024Clinical Factors Associated with Suspicious 18F-DCFPyL PSMA PET Activity in Patients Initially Managed with Radical Prostatectomy including PSA <0.5 ng/mL Eric V. Li, MD Richard Bennett, BA Austin Ho, BA Clarissa Wong, BA Ashorne K. Mahenthiran, MD Sai Kaushik Shankar Ramesh Kumar, MS Zequn Sun, PhD Hatice Savas, MD Steven P. Rowe, MD, PhD Edward M. Schaeffer, MD, PhD Hiten D. Patel, andMD, MPH Ashley RossMD, PhD Eric V. LiEric V. Li Corresponding author: Eric Li, MD 676 N. St. Clair St., Suite 2300 Chicago, IL 60611, USA Email: ([email protected]) Phone: 973-462-4395 https://orcid.org/0000-0002-5506-5755 , Richard BennettRichard Bennett Indiana University School of Medicine, Department of Urology, Indianapolis, IN 46202, United States of America , Austin HoAustin Ho Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, IL 60611, United States of America , Clarissa WongClarissa Wong Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, IL 60611, United States of America , Ashorne K. MahenthiranAshorne K. Mahenthiran Indiana University School of Medicine, Department of Urology, Indianapolis, IN 46202, United States of America , Sai Kaushik Shankar Ramesh KumarSai Kaushik Shankar Ramesh Kumar Northwestern University, Feinberg School of Medicine, Department of Preventative Medicine, Chicago, IL 60611, United States of America , Zequn SunZequn Sun Northwestern University, Feinberg School of Medicine, Department of Preventative Medicine, Chicago, IL 60611, United States of America , Hatice SavasHatice Savas Northwestern University, Feinberg School of Medicine, Department of Radiology, Chicago, IL 60611, United States of America , Steven P. RoweSteven P. Rowe University of North Carolina School of Medicine, Department of Radiology, Chapel Hill, NC 27599, United States of America , Edward M. SchaefferEdward M. Schaeffer Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, IL 60611, United States of America , Hiten D. PatelHiten D. Patel Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, IL 60611, United States of America , and Ashley RossAshley Ross Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, IL 60611, United States of America View All Author Informationhttps://doi.org/10.1097/JU.0000000000004298AboutPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: There is limited data on PSMA PET/CT for work-up of recurrence after radical prostatectomy (RP) at low PSA values. We evaluated a PSMA PET/CT cohort of post-RP patients, focusing on patients with PSA <0.5 ng/mL. Materials and Methods: We identified a retrospective cohort who underwent piflufolastat F-18 PSMA PET/CT across an eleven-hospital system from 7/2021-2/2023. PSMA positivity was determined by radiology reports. Univariable and multivariable logistic regression identified factors associated with suspicious PSMA activity. Results: Median PSA was 0.37 ng/mL (IQR 0.15, 1.29 ng/mL), with 49% of patients overall having at least one suspicious PSMA-avid lesion. Rates of scan positivity among patients with PSA <0.2 and 0.2-0.5 ng/mL were 34% and 38%, respectively. Among all patients, 25% (104/415) had pelvic disease (prostate bed or N1), and 24% (100/415) had M1 disease. Among patients with PSA <0.5 ng/mL, prior post-operative radiation was associated with suspicious PSMA activity. In the overall cohort, age, PSA at PSMA PET/CT, and RP Gleason Grade (GG) were associated with PSMA positivity. PSADT, EAU risk, and CAPRA-S were all associated with suspicious PSMA activity. Conclusions: Over one-third of patients with PSAs <0.2 ng/mL had imaging findings concerning for recurrence. Prior post-operative radiation was associated with higher rates of PSMA positivity among patients with PSA <0.5 ng/mL, and half of patients with evidence of PSMA avid distant metastatic disease underwent metastasis directed therapy. PET-PSMA imaging at low PSAs can be considered to inform salvage therapies. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Supplementary Materials Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.KeywordsProstate cancerRadical ProstatectomyPSMA PETMetrics Author Information Eric V. Li Corresponding author: Eric Li, MD 676 N. St. Clair St., Suite 2300 Chicago, IL 60611, USA Email: ([email protected]) Phone: 973-462-4395 More articles by this author Richard Bennett Indiana University School of Medicine, Department of Urology, Indianapolis, IN 46202, United States of America More articles by this author Austin Ho Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, IL 60611, United States of America More articles by this author Clarissa Wong Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, IL 60611, United States of America More articles by this author Ashorne K. Mahenthiran Indiana University School of Medicine, Department of Urology, Indianapolis, IN 46202, United States of America More articles by this author Sai Kaushik Shankar Ramesh Kumar Northwestern University, Feinberg School of Medicine, Department of Preventative Medicine, Chicago, IL 60611, United States of America More articles by this author Zequn Sun Northwestern University, Feinberg School of Medicine, Department of Preventative Medicine, Chicago, IL 60611, United States of America More articles by this author Hatice Savas Northwestern University, Feinberg School of Medicine, Department of Radiology, Chicago, IL 60611, United States of America More articles by this author Steven P. Rowe University of North Carolina School of Medicine, Department of Radiology, Chapel Hill, NC 27599, United States of America More articles by this author Edward M. Schaeffer Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, IL 60611, United States of America More articles by this author Hiten D. Patel Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, IL 60611, United States of America Co-Senior Authors More articles by this author Ashley Ross Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, IL 60611, United States of America Co-Senior Authors More articles by this author Expand All Advertisement PDF downloadLoading ...