Semiquantitative Parameters in PSMA-Targeted PET Imaging with [¹⁸F]DCFPyL: Impact of Tumor Burden on Normal Organ Uptake

Purpose: In this study, we aimed to quantitatively investigate the biodistribution of [¹⁸F]DCFPyL in patients with prostate cancer (PCa) and to determine whether uptake in normal organs correlates with an increase in tumor burden. Procedures: Fifty patients who had been imaged with [¹⁸F]DCFPyL positron emission tomography/computed tomography (PET/CT) were retrospectively included in this study. Forty of 50 (80 %) demonstrated radiotracer uptake on [¹⁸F]DCFPyL PET/CT compatible with sites of PCa. Volumes of interests (VOIs) were set on normal organs (lacrimal glands, parotid glands, submandibular glands, liver, spleen, and kidneys) and on tumor lesions. Mean standardized uptake values corrected to lean body mass (SUL_mean) and mean standardized uptake values corrected to body weight (SUV_mean) for normal organs were assessed. For the entire tumor burden, SUL_mean/max, SUV_mean, tumor volume (TV), and the total activity in the VOI were obtained using tumor segmentation. A Spearman’s rank correlation coefficient was used to investigate correlations between normal organ uptake and tumor burden. Results: There was no significant correlation between TV with the vast majority of the investigated organs (lacrimal glands, parotid glands, submandibular glands, spleen, and liver). Only the kidney showed significant correlation: With an isocontour threshold at 50 %, left kidney uptake parameters correlated significantly with TV (SUV_mean, ρ = − 0.214 and SUL_mean, ρ = − 0.176, p < 0.05, respectively). Conclusions: Only a minimal sink effect with high tumor burden in patients imaged with [¹⁸F]DCFPyL was observed. Other factors, such as a high intra-patient variability of normal organ uptake, may be a much more important consideration for personalized dosimetry with PSMA-targeted therapeutic agents structurally related to [¹⁸F]DCFPyL than the tumor burden.