Comparison of prostate-specific membrane antigen-based 18F-DCFBC PET/CT to conventional imaging modalities for detection of hormone-naïve and castration-resistant metastatic prostate cancer

Steven P. Rowe, Katarzyna J. MacUra, Anthony Ciarallo, Esther Mena, Amanda Blackford, Rosa Nadal, Emmanuel S. Antonarakis, Mario A. Eisenberger, Michael A. Carducci, Ashley E. Ross, Philip W. Kantoff, Daniel P. Holt, Robert F. Dannals, Ronnie C. Mease, Martin G. Pomper, Steve Y. Cho

Research output: Contribution to journalArticle

Abstract

Conventional imaging modalities (CIMs) have limited sensitivity and specificity for detection of metastatic prostate cancer. We examined the potential of a first-in-class radiofluorinated smallmolecule inhibitor of prostate-specific membrane antigen (PSMA), N-[N-[(S)-1,3-dicarboxypropyl]carbamoyl]-4-18F-fluorobenzyl-L-cysteine (18F-DCFBC), to detect metastatic hormone-naïve (HNPC) and castration-resistant prostate cancer (CRPC). Methods: Seventeen patients were prospectively enrolled (9 HNPC and 8 CRPC); 16 had CIM evidence of new or progressive metastatic prostate cancer and 1 had high clinical suspicion of metastatic disease. 18F-DCFBC PET/CT imaging was obtained with 2 successive PET scans starting at 2 h after injection. Patients were imaged with CIM at approximately the time of PET. A lesion-by-lesion analysis of PET to CIM was performed in the context of either HNPC or CRPC. The patients were followed with available clinical imaging as a reference standard to determine the true nature of identified lesions on PET and CIM. Results: On the lesion-by-lesion analysis, 18F-DCFBC PET was able to detect a larger number of lesions (592 positive with 63 equivocal) than CIM (520 positive with 61 equivocal) overall, in both HNPC and CRPC patients. 18F-DCFBC PET detection of lymph nodes, bone lesions, and visceral lesions was superior to CIM. When intrapatient clustering effects were considered, 18F-DCFBC PET was estimated to be positive in a large proportion of lesions that would be negative or equivocal on CIM (0.45). On follow-up, the sensitivity of 18F-DCFBC PET (0.92) was superior to CIM (0.71). 18F-DCFBC tumor uptake was increased at the later PET time point (?2.5 h after injection), with background uptake showing a decreasing trend on later PET. Conclusion: PET imaging with 18FDCFBC, a small-molecule PSMA-targeted radiotracer, detected more lesions than CIM and promises to diagnose and stage patients with metastatic prostate cancer more accurately than current imaging methods.

Original languageEnglish (US)
Pages (from-to)46-53
Number of pages8
JournalJournal of Nuclear Medicine
Volume57
Issue number1
DOIs
StatePublished - Jan 1 2016

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Keywords

  • Bone scan
  • Computed tomography
  • Metastatic prostate cancer
  • Positron emission tomography
  • Prostate-specific membrane antigen

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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