Higher Preoperative Maximum Standardised Uptake Values (SUV max ) Are Associated with Higher Biochemical Recurrence Rates after Robot-Assisted Radical Prostatectomy for [ 68 Ga]Ga-PSMA-11 and [ 18 F]DCFPyL Positron Emission Tomography/Computed Tomography

This study aimed to investigate the association between the Ga- or F-radiolabeled prostate-specific membrane antigen (PSMA) tracer expression, represented by the maximum standardised uptake value (SUV ) of the dominant intraprostatic lesion, and biochemical recurrence (BCR) in primary prostate cancer (PCa) patients prior to robot-assisted radical prostatectomy (RARP). This was a retrospective, multi-centre cohort study of 446 patients who underwent [ Ga]Ga-PSMA-11 ( = 238) or [ F]DCFPyL ( = 206) Positron Emission Tomography/Computed Tomography (PET/CT) imaging prior to RARP. SUV was measured in the dominant intraprostatic PCa lesions. [ F]DCFPyL patients were scanned 60 ([ F]DCFPyL-60; = 106) or 120 ([ F]DCFPyL-120; = 120) minutes post-injection of a radiotracer and were analysed separately. To normalise the data, SUV was log transformed for further analyses. During a median follow-up of 24 months, 141 (30.4%) patients experienced BCR. Log SUV was a significant predictor for BCR ( < 0.001). In the multivariable analysis accounting for these preoperative variables: initial prostate-specific antigen (PSA), radiologic tumour stage (mT), the biopsy International Society of Urological Pathology grade group (bISUP) and the prostate imaging and reporting data system (PI-RADS), Log SUV was found to be an independent predictor for BCR in [ Ga]Ga-PSMA-11 (HR 1.32, 0.04) and [ F]DCFPyL-120 PET/CT scans (HR 1.55, 0.04), but not in [ F]DCFPyL-60 ones (HR 0.92, 0.72). The PSMA expression of the dominant intraprostatic lesion proved to be an independent predictor for BCR in patients with primary PCa who underwent [ Ga]Ga-PSMA-11 or [ F]DCFPyL-120 PET/CT scans, but not in those who underwent [ F]DCFPyL-60 PET/CT scans.