Biochemical recurrence (BCR) is observed in about 20-50% of individuals with localized prostate cancer (PC) after undergoing radical prostatectomy (RP). Standard imaging methods generally fail to identify early relapse, either local or systemic, when PSA concentrations are low. The use of 18F-DCFPyL PSMA positron emission tomography/computed tomography (PET/CT) provides improved diagnostic precision and detection sensitivity in recurrent cases. This research investigates how effectively 18F-DCFPyL PET/CT identifies early BCR following RP and evaluates its influence on clinical decisions and treatment adjustments. In a forward-looking study, 85 men with BCR (PSA range 0.2-2.0 ng/mL) and unremarkable findings on traditional imaging were assessed using 18F-DCFPyL PET/CT. Detection rates (DRs) were compared with clinical parameters such as PSA levels and PSA doubling time (DT-PSA). Identified foci were classified as local recurrence, lymphatic spread, bone lesions, or visceral metastasis. Therapeutic approaches were revised in light of PET/CT outcomes. 18F-DCFPyL PET/CT revealed recurrent lesions in 53% of subjects. DRs were 31.3%, 60%, and 77.8% in patients with PSA levels below 0.5, between 0.5-1, and above 1 ng/mL, respectively. Shorter DT-PSA intervals (<6 months) showed higher DRs (61.5%). Detected lesions were categorized as 22.2% local recurrence, 51.1% nodal involvement, 20% skeletal, and 6.7% visceral disease. Receiver operating characteristic (ROC) analysis indicated 0.55 ng/mL and 9.2 months as the optimal PSA and DT-PSA thresholds. Based on PET-positive results, treatment plans were altered in 84.4% of cases. 18F-DCFPyL PET/CT demonstrates strong capability in identifying recurrent PC at minimal PSA values and substantially influences therapeutic management. These results endorse its integration into clinical guidelines for early-stage BCR assessment.
