Emerging PET/CT Agent Shows Promise in Detecting PCa Recurrence in Patients with Low PSA Levels

New research suggests the positron emission tomography/computed tomography (PET/CT) agent ¹⁸F-DCFPyL may be advantageous in diagnosing early recurrence of prostate cancer (PCa) in patients with low prostate-specific antigen (PSA) levels.

In a retrospective study recently presented at American Society of Clinical Oncology Genitourinary Cancers (ASCO-GU) Symposium, researchers reviewed ¹⁸F-DCFPyL (Pylarify, Lantheus) PET/CT data for 129 patients, including 93 patients with PSA levels 0.2 < 0.5 ng/ml and 36 patients with PSA levels ranging between .05 and 0.2 ng/ml. Reviewers also used the adjunctive Prostate Cancer Molecular Imaging Standardized Evaluation (aPROMISE) platform, according to the study.

The study authors found that ¹⁸F-DCFPyL enabled detection of recurrent PCa in 51 percent of patients (47/93) with 0.2 to 0.5 ng/ml PSA levels and in 36 percent of men (13/36) with .05 to 0.2 ng/ml PSA levels.

“¹⁸F-DCFPyL PET/CT demonstrates high detection rate for recurrent prostate cancer even in patients with minimally detectable PSA levels, highlighting its potential as a valuable tool in early identification of metastatic disease,” wrote lead study author Ida Sonni, M.D., a project scientist affiliated with the Department of Radiology at the University of California, Los Angeles (UCLA), and colleagues.

The use of ¹⁸F-DCFPyL also revealed a combination of lymph node and bone metastasis in 33 percent of the patients with .05 < 0.2 ng/ml PSA levels and 42 percent of cases in men with 0.2 < 0.5 ng/ml PSA levels, according to the study authors.

“These findings suggest that current thresholds for initiating PSMA PET/CT imaging in (biochemical recurrence) patients may need reconsideration to optimize early detection and subsequent clinical management,” noted Sonni and colleagues. “Further studies are necessary to refine guidelines and assess the cost-effectiveness of incorporating PSMA imaging at very low PSA levels.”

Reference

1. Sonni I, Nickols NG, Niknam K, Schaffer D, Berenji G, Rettig M. Early detection of recurrent prostate cancer using 18F-DCFPyL PET/CT in patients with minimal PSA levels. Presented at the American Society of Clinical Oncology Genitourinary Cancers (ASCO-GU) Symposium, February 13-15, 2025, San Francisco, Calif. Available at: https://conferences.asco.org/gu/abstracts-posters .