18F-DCFBC PET/CT for PSMA-based detection and characterization of primary prostate cancer

Steven P. Rowe, Kenneth L. Gage, Sheila F. Faraj, Katarzyna J. Macura, Toby C. Cornish, Nilda Gonzalez-Roibon, Gunes Guner, Enrico Munari, Alan W. Partin, Christian P. Pavlovich, Misop Han, H. Ballentine Carter, Trinity J. Bivalacqua, Amanda Blackford, Daniel Holt, Robert F. Dannals, George J. Netto, Martin A. Lodge, Ronnie C. Mease, Martin G. PomperSteve Y. Cho

Research output: Contribution to journalArticle

Abstract

We previously demonstrated the ability to detect metastatic prostate cancer using N-[N-[(S)-1,3-dicarboxypropyl]carbamoyl]- 4-18F-fluorobenzyl-L-cysteine (18F-DCFBC), a low-molecular-weight radiotracer that targets the prostate-specific membrane antigen (PSMA). PSMA has been shown to be associated with higher Gleason grade and more aggressive disease. An imaging biomarker able to detect clinically significant high-grade primary prostate cancer reliably would address an unmet clinical need by allowing for riskadapted patient management. Methods: We enrolled 13 patients with primary prostate cancer who were imaged with 18F-DCFBC PET before scheduled prostatectomy, with 12 of these patients also undergoing pelvic prostate MR imaging. Prostate 18F-DCFBC PET was correlated with MR imaging and histologic and immunohistochemical analysis on a prostate-segment (12 regions) and dominantlesion basis. There were no incidental extraprostatic findings on PET suggestive of metastatic disease. Results: MR imaging was more sensitive than 18F-DCFBC PET for detection of primary prostate cancer on a per-segment (sensitivities of up to 0.17 and 0.39 for PET and MR imaging, respectively) and per-dominant-lesion analysis (sensitivities of 0.46 and 0.92 for PET and MR imaging, respectively). However, 18F-DCFBC PET was more specific than MR imaging by per-segment analysis (specificities of 0.96 and 0.89 for PET and MR imaging for corresponding sensitivity, respectively) and specific for detection of high-grade lesions (Gleason 8 and 9) greater than 1.0 mL in size (4/4 of these patients positive by PET). 18F-DCFBC uptake in tumors was positively correlated with Gleason score (r 5 0.64; PSMA expression, r 5 0.47; and prostate-specific antigen, r 5 0.52). There was significantly lower 18F-DCFBC uptake in benign prostatic hypertrophy than primary tumors (median maximum standardized uptake value, 2.2 vs. 3.5; P 5 0.004). Conclusion: Although the sensitivity of 18F-DCFBC for primary prostate cancer was less than MR imaging, 18F-DCFBC PET was able to detect the more clinically significant high-grade and larger-volume tumors (Gleason score 8 and 9) with higher specificity than MR imaging. In particular, there was relatively low 18F-DCFBC PET uptake in benign prostatic hypertrophy lesions, compared with cancer in the prostate, which may allow for more specific detection of primary prostate cancer by 18F-DCFBC PET. This study demonstrates the utility of PSMA-based PET, which may be used in conjunction with MR imaging to identify clinically significant prostate cancer.

Original languageEnglish (US)
Pages (from-to)1003-1010
Number of pages8
JournalJournal of Nuclear Medicine
Volume56
Issue number7
DOIs
StatePublished - Jul 1 2015

Keywords

  • MRI
  • PET/CT
  • Primary prostate cancer
  • Prostate specific membrane antigen (PSMA)
  • Prostatectomy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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