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Comparison of [(18)F]DCFPyL and [ (68)Ga]Ga-PSMA-HBED-CC for PSMA-PET Imaging in Patients with Relapsed Prostate Cancer.

Dietlein M, Kobe C, Kuhnert G, Stockter S, Fischer T, Schomäcker K, Schmidt M, Dietlein F, Zlatopolskiy BD, Krapf P, Richarz R, Neubauer S, Drzezga A, Neumaier B - Mol Imaging Biol (2015)

Bottom Line: A systematic comparison was carried out between results obtained with both tracers with regard to the number of detected PSMA-positive lesions, the standardized uptake value (SUV)max and the lesion to background ratios.The mean SUVmax in the concordant [(18)F]DCFPyL PSMA-positive lesions was significantly higher as compared to [(68)Ga]Ga-PSMA-HBED-CC (14.5 vs. 12.2, p = 0.028, n = 15).The mean tumor to background ratios (n = 15) were significantly higher for [(18)F]DCFPyL compared to [(68)Ga]Ga-PSMA-HBED-CC using kidney, spleen, or parotid as reference organs (p = 0.006, p = 0.002, p = 0.008), but no significant differences were found using the liver (p = 0.167) or the mediastinum (p = 0.363) as reference organs. [(18)F]DCFPyL PET/CT provided a high image quality and visualized small prostate lesions with excellent sensitivity. [(18)F]DCFPyL represents a highly promising alternative to [(68)Ga]Ga-PSMA-HBED-CC for PSMA-PET/CT imaging in relapsed prostate cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany, markus.dietlein@uk-koeln.de.

ABSTRACT

Purpose: Gallium-68 (Ga-68)-labeled tracers for imaging expression of the prostate-specific membrane antigen (PSMA) such as the [(68)Ga]Ga-PSMA-HBED-CC have already demonstrated high potential for the detection of recurrent prostate cancer. However, compared to Ga-68, a labeling with fluorine-18 (F-18) would offer advantages with respect to availability, production amount, and image resolution. [(18)F]DCFPyL is a promising F-18-labeled candidate for PSMA-positron emission tomography (PET) imaging that has been recently introduced. In the current study, we aimed to compare [(68)Ga]Ga-PSMA-HBED-CC and [(18)F]DCFPyL for clinical use in biochemically relapsed prostate cancer.

Procedures: In 14 selected patients with PSA relapse of prostate cancer, [(18)F]DCFPyL PET/X-ray computed tomography (CT) was performed in addition to [(68)Ga]Ga-PSMA-HBED-CC PET/CT. A systematic comparison was carried out between results obtained with both tracers with regard to the number of detected PSMA-positive lesions, the standardized uptake value (SUV)max and the lesion to background ratios.

Results: All suspicious lesions identified by [(68)Ga]Ga-PSMA-HBED-CC were also detected with [(18)F]DCFPyL. In three patients, additional lesions were observed using [(18)F]DCFPyL PET/CT. The mean SUVmax in the concordant [(18)F]DCFPyL PSMA-positive lesions was significantly higher as compared to [(68)Ga]Ga-PSMA-HBED-CC (14.5 vs. 12.2, p = 0.028, n = 15). The mean tumor to background ratios (n = 15) were significantly higher for [(18)F]DCFPyL compared to [(68)Ga]Ga-PSMA-HBED-CC using kidney, spleen, or parotid as reference organs (p = 0.006, p = 0.002, p = 0.008), but no significant differences were found using the liver (p = 0.167) or the mediastinum (p = 0.363) as reference organs.

Conclusion: [(18)F]DCFPyL PET/CT provided a high image quality and visualized small prostate lesions with excellent sensitivity. [(18)F]DCFPyL represents a highly promising alternative to [(68)Ga]Ga-PSMA-HBED-CC for PSMA-PET/CT imaging in relapsed prostate cancer.

No MeSH data available.


Related in: MedlinePlus

Patient no. 2 with a rising PSA level of 4.7 ng/ml. a Low-dose CT in bone window and b [18F]DCFPyL PET/CT were suspicious of bone metastasis in vertebra L2, hard to discern in the c [68Ga]Ga-PSMA-HBED-CC PET/CT. Imaging was performed on a Biograph 16 PET/CT.
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Fig3: Patient no. 2 with a rising PSA level of 4.7 ng/ml. a Low-dose CT in bone window and b [18F]DCFPyL PET/CT were suspicious of bone metastasis in vertebra L2, hard to discern in the c [68Ga]Ga-PSMA-HBED-CC PET/CT. Imaging was performed on a Biograph 16 PET/CT.

Mentions: The bone metastases in the lumbar vertebra L2 (patient 2) and in the thoracal vertebral Th3 (patient 12) were confirmed by CT retrospectively. In patient 7, a concordant left iliac PSMA-positive lymph node was detected with both tracers and an additional F-18 PSMA-positive pelvic lymph was reported. This patient underwent surgical lymph node resection, and the left iliac metastasis was confirmed histologically. The additional pelvic metastasis was not detected by salvage lymph node dissection, but PSA remained increased postoperatively, indicating that this lesion may have represented the remaining PSA-producing tissue. In 1 patient, the solitary PSMA spot in the irradiated prostate, seen in the [68Ga]Ga-PSMA-HBED-CC PET/CT and in the [18F]DCFPyL PET/CT, was not confirmed by core biopsy (patient 4). In 1 patient, the concordant solitary PSMA-avid lymph node metastasis was confirmed histologically by systematic lymphadenectomy, while core biopsy was negative for local relapse despite a focal PSMA concentration within the irradiated prostate (patient 1). Examples of the PSMA-positive lesions are shown in Figs. 1, 2, 3, and 4.Fig. 1


Comparison of [(18)F]DCFPyL and [ (68)Ga]Ga-PSMA-HBED-CC for PSMA-PET Imaging in Patients with Relapsed Prostate Cancer.

Dietlein M, Kobe C, Kuhnert G, Stockter S, Fischer T, Schomäcker K, Schmidt M, Dietlein F, Zlatopolskiy BD, Krapf P, Richarz R, Neubauer S, Drzezga A, Neumaier B - Mol Imaging Biol (2015)

Patient no. 2 with a rising PSA level of 4.7 ng/ml. a Low-dose CT in bone window and b [18F]DCFPyL PET/CT were suspicious of bone metastasis in vertebra L2, hard to discern in the c [68Ga]Ga-PSMA-HBED-CC PET/CT. Imaging was performed on a Biograph 16 PET/CT.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4493776&req=5

Fig3: Patient no. 2 with a rising PSA level of 4.7 ng/ml. a Low-dose CT in bone window and b [18F]DCFPyL PET/CT were suspicious of bone metastasis in vertebra L2, hard to discern in the c [68Ga]Ga-PSMA-HBED-CC PET/CT. Imaging was performed on a Biograph 16 PET/CT.
Mentions: The bone metastases in the lumbar vertebra L2 (patient 2) and in the thoracal vertebral Th3 (patient 12) were confirmed by CT retrospectively. In patient 7, a concordant left iliac PSMA-positive lymph node was detected with both tracers and an additional F-18 PSMA-positive pelvic lymph was reported. This patient underwent surgical lymph node resection, and the left iliac metastasis was confirmed histologically. The additional pelvic metastasis was not detected by salvage lymph node dissection, but PSA remained increased postoperatively, indicating that this lesion may have represented the remaining PSA-producing tissue. In 1 patient, the solitary PSMA spot in the irradiated prostate, seen in the [68Ga]Ga-PSMA-HBED-CC PET/CT and in the [18F]DCFPyL PET/CT, was not confirmed by core biopsy (patient 4). In 1 patient, the concordant solitary PSMA-avid lymph node metastasis was confirmed histologically by systematic lymphadenectomy, while core biopsy was negative for local relapse despite a focal PSMA concentration within the irradiated prostate (patient 1). Examples of the PSMA-positive lesions are shown in Figs. 1, 2, 3, and 4.Fig. 1

Bottom Line: A systematic comparison was carried out between results obtained with both tracers with regard to the number of detected PSMA-positive lesions, the standardized uptake value (SUV)max and the lesion to background ratios.The mean SUVmax in the concordant [(18)F]DCFPyL PSMA-positive lesions was significantly higher as compared to [(68)Ga]Ga-PSMA-HBED-CC (14.5 vs. 12.2, p = 0.028, n = 15).The mean tumor to background ratios (n = 15) were significantly higher for [(18)F]DCFPyL compared to [(68)Ga]Ga-PSMA-HBED-CC using kidney, spleen, or parotid as reference organs (p = 0.006, p = 0.002, p = 0.008), but no significant differences were found using the liver (p = 0.167) or the mediastinum (p = 0.363) as reference organs. [(18)F]DCFPyL PET/CT provided a high image quality and visualized small prostate lesions with excellent sensitivity. [(18)F]DCFPyL represents a highly promising alternative to [(68)Ga]Ga-PSMA-HBED-CC for PSMA-PET/CT imaging in relapsed prostate cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany, markus.dietlein@uk-koeln.de.

ABSTRACT

Purpose: Gallium-68 (Ga-68)-labeled tracers for imaging expression of the prostate-specific membrane antigen (PSMA) such as the [(68)Ga]Ga-PSMA-HBED-CC have already demonstrated high potential for the detection of recurrent prostate cancer. However, compared to Ga-68, a labeling with fluorine-18 (F-18) would offer advantages with respect to availability, production amount, and image resolution. [(18)F]DCFPyL is a promising F-18-labeled candidate for PSMA-positron emission tomography (PET) imaging that has been recently introduced. In the current study, we aimed to compare [(68)Ga]Ga-PSMA-HBED-CC and [(18)F]DCFPyL for clinical use in biochemically relapsed prostate cancer.

Procedures: In 14 selected patients with PSA relapse of prostate cancer, [(18)F]DCFPyL PET/X-ray computed tomography (CT) was performed in addition to [(68)Ga]Ga-PSMA-HBED-CC PET/CT. A systematic comparison was carried out between results obtained with both tracers with regard to the number of detected PSMA-positive lesions, the standardized uptake value (SUV)max and the lesion to background ratios.

Results: All suspicious lesions identified by [(68)Ga]Ga-PSMA-HBED-CC were also detected with [(18)F]DCFPyL. In three patients, additional lesions were observed using [(18)F]DCFPyL PET/CT. The mean SUVmax in the concordant [(18)F]DCFPyL PSMA-positive lesions was significantly higher as compared to [(68)Ga]Ga-PSMA-HBED-CC (14.5 vs. 12.2, p = 0.028, n = 15). The mean tumor to background ratios (n = 15) were significantly higher for [(18)F]DCFPyL compared to [(68)Ga]Ga-PSMA-HBED-CC using kidney, spleen, or parotid as reference organs (p = 0.006, p = 0.002, p = 0.008), but no significant differences were found using the liver (p = 0.167) or the mediastinum (p = 0.363) as reference organs.

Conclusion: [(18)F]DCFPyL PET/CT provided a high image quality and visualized small prostate lesions with excellent sensitivity. [(18)F]DCFPyL represents a highly promising alternative to [(68)Ga]Ga-PSMA-HBED-CC for PSMA-PET/CT imaging in relapsed prostate cancer.

No MeSH data available.


Related in: MedlinePlus