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. 2021 Sep 1;62(9):1270-1273.
doi: 10.2967/jnumed.120.259226. Epub 2021 Jan 15.

Detection of Early Progression with 18F-DCFPyL PET/CT in Men with Metastatic Castration-Resistant Prostate Cancer Receiving Bipolar Androgen Therapy

Mark C Markowski  1 , Pedro Isaacsson Velho  2   3 , Mario A Eisenberger  2 , Martin G Pomper  2   4 , Kenneth J Pienta  5 , Michael A Gorin  5 , Emmanuel S Antonarakis  2 , Samuel R Denmeade  2 , Steven P Rowe  2   4
Affiliations

Detection of Early Progression with 18F-DCFPyL PET/CT in Men with Metastatic Castration-Resistant Prostate Cancer Receiving Bipolar Androgen Therapy

Mark C Markowski et al. J Nucl Med. .

Abstract

Bipolar androgen therapy (BAT) is an emerging treatment for metastatic castration-resistant prostate cancer (mCRPC). 18F-DCFPyL is a small-molecule PET radiotracer targeting prostate-specific membrane antigen (PSMA). We analyzed the utility of 18F-DCFPyL PET/CT in determining clinical response to BAT. Methods: Six men with mCRPC receiving BAT were imaged with 18F-DCFPyL PET/CT at baseline and after 3 mo of treatment. Progression by PSMA-targeted PET/CT was defined as the appearance of any new 18F-DCFPyL-avid lesion. Results: Three of 6 (50%) patients had progression on 18F-DCFPyL PET/CT. All 3 had stable disease or better on contemporaneous conventional imaging. Radiographic progression on CT or bone scanning was observed within 3 mo of progression on 18F-DCFPyL PET/CT. For the 3 patients who did not have progression on 18F-DCFPyL PET/CT, radiographic progression was not observed for at least 6 mo. Conclusion: New radiotracer-avid lesions on 18F-DCFPyL PET/CT in men with mCRPC undergoing BAT can indicate early progression.

Keywords: PSMA; early progression; testosterone.

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Figures

None
Graphical abstract
FIGURE 1.
FIGURE 1.
Changes in 18F-DCFPyL PET/CT imaging after 3 mo of BAT. Baseline and follow-up maximum-intensity-projection whole-body images are shown for each patient included in study. For patients 4–6, representative new lesions or sites of progression are demarcated with arrows. Additional new lesions may be hidden by normal uptake or other sites of disease.
FIGURE 2.
FIGURE 2.
Swimmer plot showing radiographic response/progression on BAT. All patients were followed until radiographic progression. 18F-DCFPyL PET/CT imaging was performed before start of BAT and after 3 mo of treatment. Patients 1–3 had no progression noted with 18F-DCFPyL. Patients 4–6 had new 18F-DCFPyL–avid lesions. These data suggest that disease progression on PSMA-targeted PET imaging precedes detection on conventional imaging.
See this image and copyright information in PMC

References

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