Open Access

ARTICLE

Image acquisition and interpretation of 18F-DCFPyL (piflufolastat F 18) PET/CT: How we do it

Steven P. Rowe^1,2,3, Andrew F. Voter^1,4, Rudolf A. Werner^1,5, Katherine A. Zukotynski^6,7,8, Martin G. Pomper^1,2,3, Michael A. Gorin⁹, Lilja B. Solnes^1,3

1 The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
2 The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
3 Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
4 Transitional Year Residency Program, Aurora St. Luke’s Medical Center, Advocate Aurora Health, Milwaukee, Wisconsin, USA
5 Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
6 Departments of Radiology and Medicine, McMaster University, Hamilton, Ontario, Canada
7 Department of Medical Imaging, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
8 Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
9 Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Address correspondence to Dr. Steven P. Rowe, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287 USA

Canadian Journal of Urology 2023, 30(1), 11432-11437.

Abstract

Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) is rapidly becoming widely accepted as the standard-of-care for imaging of men with prostate cancer. Labeled indications for regulatoryapproved agents include primary staging and recurrent disease in men at risk of metastases. The first commercial PSMA PET agent to become available was 18F-DCFPyL (piflufolastat F 18), a radiofluorinated small molecule with high-affinity for PSMA. The regulatory approval of 18F-DCFPyL hinged upon two key, multi-center, registration trials, OSPREY (patient population: highrisk primary staging) and CONDOR (patient population: biochemical recurrence). In this manuscript, we will (1) review key findings from the OSPREY and CONDOR trials, (2) discuss the clinical acquisition protocol we use for 18F-DCFPyL PET scanning, (3) present information on important pearls and pitfalls, (4) provide an overview of the PSMA reporting and data system (PSMA-RADS) interpretive framework, and (5) posit important future directions for research in PSMA PET. Our overall goal is to provide a brief introduction for practices and academic groups that are adopting 18F-DCFPyL PET scans for use in their patients with prostate cancer.

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