SUVs Are Adequate Measures of Lesional 18 F-DCFPyL Uptake in Patients with Low Prostate Cancer Disease Burden.

In prostate cancer (PCa) patients, the tumor-to-blood ratio (TBR) has been validated as the preferred simplified method for lesional ¹⁸ F-DCFPyL (a radiolabeled prostate-specific membrane antigen ligand) uptake quantification on PET. In contrast to SUVs, the TBR accounts for variability in arterial input functions caused by differences in total tumor burden between patients (the sink effect). However, TBR depends strongly on tracer uptake interval and has worse repeatability and is less applicable in clinical practice than SUVs. We investigated whether SUV could provide adequate quantification of ¹⁸ F-DCFPyL uptake on PET/CT in a patient cohort with low PCa burden. Methods: In total, 116 patients with PCa undergoing ¹⁸ F-DCFPyL PET/CT imaging were retrospectively included. All ¹⁸ F-DCFPyL-avid lesions suspected of being PCa were semiautomatically delineated. SUV _peak was plotted against TBR for the most intense lesion of each patient. The correlation of SUV _peak and TBR was evaluated using linear regression and was stratified for patients undergoing PET/CT for primary staging, patients undergoing restaging at biochemical recurrence, and patients with metastatic castration-resistant PCa. Moreover, the correlation was evaluated as a function of tracer uptake time, prostate-specific antigen level, and PET-positive tumor volume. Results: In total, 436 lesions were delineated (median, 1 per patient; range, 1-66). SUV _peak correlated well with TBR in patients with PCa and a total tumor volume of less than 200 cm ³ ( R ² = 0.931). The correlation between SUV and TBR was not affected by disease setting, prostate-specific antigen level, or tumor volume. SUV _peak depended less on tracer uptake time than did TBR. Conclusion: For ¹⁸ F-DCFPyL PET/CT, SUV _peak correlates strongly with TBR. Therefore, it is a valuable simplified, semiquantitative measurement in patients with low-volume PCa (<200 cm ³ ). SUV _peak can therefore be applied in ¹⁸ F-DCFPyL PET assessment as an imaging biomarker to characterize tumors and to monitor treatment outcomes.
(© 2021 by the Society of Nuclear Medicine and Molecular Imaging.)