Detection of prostate cancer with 18F-DCFPyL PET/CT compared to final histopathology of radical prostatectomy specimens: is PSMA-targeted biopsy feasible? The DeTeCT trial - Report - MDSpire
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Detection of prostate cancer with 18F-DCFPyL PET/CT compared to final histopathology of radical prostatectomy specimens: is PSMA-targeted biopsy feasible? The DeTeCT trial
Clinical Report: Efficacy of 18F-DCFPyL PET/CT for Prostate Cancer Detection
Overview
This prospective study evaluated the accuracy of 18F-DCFPyL PET/CT imaging in localizing primary prostate cancer by comparing imaging results to histopathology from radical prostatectomy specimens. The study demonstrated high detection rates and potential for guiding targeted biopsies, supporting the viability of PSMA-targeted biopsy in clinical practice.
Background
Prostate cancer is the most common malignancy in men in the Western world, requiring histopathological confirmation typically obtained via systematic prostate biopsies. Conventional biopsies have limitations due to sampling errors, leading to false negatives and inaccurate risk assessment. Multi-parametric MRI has improved targeted biopsy approaches, but novel imaging modalities like PSMA-PET/CT, which targets prostate-specific membrane antigen overexpressed in malignant cells, offer enhanced detection and staging capabilities. This study is the first prospective evaluation of 18F-DCFPyL PET/CT for primary prostate cancer detection compared to final histopathology.
Data Highlights
Parameter
Value/Description
Patient Population
Intermediate or high-risk prostate cancer undergoing radical prostatectomy
Radiotracer Dose
Median 313 MBq 18F-DCFPyL (IQR 299–324 MBq)
Imaging Timing
Median 118 min post-injection (IQR 113–122 min), median 5.4 weeks before surgery
5-point PSMA-RADS scale; scores 4–5 considered positive
Histopathology
12-segment prostate mapping with Gleason score and ISUP grade; clinically significant PCa defined as Gleason ≥ 3+4 or stage ≥ pT3a
Key Findings
18F-DCFPyL PET/CT demonstrated high accuracy in localizing primary prostate cancer within the prostate gland compared to final histopathology.
PSMA-RADS scores of 4–5 were used to define positive lesions, correlating strongly with histopathological tumor presence.
The imaging allowed identification of two segments per patient for potential targeted biopsy based on visual and semi-quantitative SUVmax assessment.
18F-DCFPyL PET/CT also provided assessment of local tumor stage, including detection of extracapsular extension and seminal vesicle invasion.
The study supports the use of PSMA-PET/CT as a complementary or alternative imaging modality to mpMRI for guiding prostate biopsies.
Clinical Implications
18F-DCFPyL PET/CT can improve prostate cancer detection accuracy and guide targeted biopsies, potentially reducing sampling errors associated with systematic biopsies. Its ability to simultaneously stage local tumor extent and screen for metastases may streamline diagnostic workflows and enhance risk stratification in intermediate and high-risk patients.
Conclusion
This study validates 18F-DCFPyL PET/CT as a highly accurate imaging modality for primary prostate cancer localization and staging, supporting its clinical utility in guiding targeted prostate biopsies and improving diagnostic precision.
References
Jansen et al. -- Synthesis and application of 18F-DCFPyL
European Association of Urology Guidelines -- Prostate Cancer Diagnosis and Management
by Y. J. L. Bodar, B. H. E. Jansen, J. P. van der Voorn, G. J. C. Zwezerijnen, D. Meijer, J. A. Nieuwenhuijzen, R. Boellaard, N. H. Hendrikse, O. S. Hoekstra, R. J. A. van Moorselaar, D. E. Oprea-Lager, A. N. Vis
