A Prospective Comparison of 18F-Sodium Fluoride PET/CT and PSMA-Targeted 18F-DCFBC PET/CT in Metastatic Prostate Cancer

Stephanie A. Harmon, Ethan Bergvall, Esther Mena, Joanna H. Shih, Stephen Adler, Yolanda McKinney, Sherif Mehralivand, Deborah E. Citrin, Anna Couvillon, Ravi A. Madan, James L. Gulley, Ronnie C. Mease, Paula M. Jacobs, Martin G. Pomper, Baris Turkbey, Peter L. Choyke, M. Liza Lindenberg

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


The purpose of this study was to compare the diagnostic performance of 18F-DCFBC PET/CT, a first-generation 18F-labeled prostate-specific membrane antigen (PSMA)-targeted agent, and 18F-NaF PET/CT, a sensitive marker of osteoblastic activity, in a prospective cohort of patients with metastatic prostate cancer. Methods: Twenty-eight prostate cancer patients with metastatic disease on conventional imaging prospectively received up to 4 PET/CT scans. All patients completed baseline 18F-DCFBC PET/ CT and 18F-NaF PET/CT scans, and 23 patients completed follow- up imaging, with a median follow-up interval of 5.7 mo (range, 4.2-12.6 mo). Lesion detection was compared across the 2 PET/CT agents at each time point. Detection and SUV characteristics of each PET/CT agent were compared with serum prostate-specific antigen (PSA) levels and treatment status at the time of baseline imaging using nonparametric statistical testing (Spearman correlation, Wilcoxon rank). Results: Twenty-six patients had metastatic disease detected on 18FNaF or 18F-DCFBC at baseline, and 2 patients were negative on both scans. Three patients demonstrated soft tissue-only disease. Of 241 lesions detected at baseline, 56 were soft-tissue lesions identified by 18F-DCFBC only and 185 bone lesions detected on 18F-NaF or 18FDCFBC. 18F-NaF detected significantly more bone lesions than 18FDCFBC (P < 0.001). Correlation of PSA with patient-level SUV metrics was strong in 18F-DCFBC (p > 0.5, P < 0.01) and poor in 18F-NaF (p < 0.3, P > 0.1). When PSA levels were combined with treatment status, patients with below-median levels of PSA (<2 ng/mL) on androgen deprivation therapy (n = 11) demonstrated more lesions on 18F-NaF than 18F-DCFBC (P = 0.02). In PSA greater than 2 ng/mL, patients on androgen deprivation therapy (n = 8) showed equal to or more lesions on 18F-DCFBC than on 18F-NaF. Conclusion: The utility of PSMA-targeting imaging in metastatic prostate cancer appears to depend on patient disease course and treatment status. Compared with 18F-NaF PET/CT, 18F-DCFBC PET/CT detected significantly fewer bone lesions in the setting of early or metastatic castrate-sensitive disease on treatment. However, in advanced metastatic castrate-resistant prostate cancer, 18F-DCFBC PET/CT shows good concordance with NaF PET/CT.

Original languageEnglish (US)
Pages (from-to)1665-1671
Number of pages7
JournalJournal of Nuclear Medicine
Issue number11
StatePublished - Nov 1 2018


  • Metastatic prostate cancer
  • NaF
  • PET/CT imaging
  • PSMA

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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