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Tumor Localization of 16ß-18F-Fluoro-5{alpha}-Dihydrotestosterone Versus 18F-FDG in Patients with Progressive, Metastatic Prostate Cancer

Steven M. Larson, MD1, Michael Morris, MD2, Ilonka Gunther, PhD1, Brad Beattie, BA1, John L. Humm, PhD3, Timothy A. Akhurst, MD1, Ronald D. Finn, PhD1, Yusuf Erdi, PhD3, Keith Pentlow, MS3, Jon Dyke, PhD3, Olivia Squire, RN1, William Bornmann, PhD1, Timothy McCarthy4, Michael Welch, PhD4 and Howard Scher, MD2

1 Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
2 Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
3 Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
4 Mallinckrodt Institute, Washington University School of Medicine, St. Louis, Missouri



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  		FIGURE 1. 18F-FDHT scan of patient 6 (Table 1) displayed in mip format to allow better visualization of the whole-body distribution of this tracer. There is uptake in the skull, right upper humerus, and upper thorax at 2 sites.

 


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  		FIGURE 2. 18F-FDHT (A) and 18F-FDG (B) of patient 7 (Table 1) displayed in mip format.

 


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  		FIGURE 3. Prostate tumor section from a biopsy sample obtained from patient 1 stained with hematoxylin–eosin and also showing positive for androgen by immunohistochemistry (brown stain).

 


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  		FIGURE 4. Fraction of 18F-FDHT vs. total 18F activity from blood samples of 4 patients (A–D), who had repeated blood samples drawn over the 60 min after injection.

 


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  		FIGURE 5. 18F-FDHT tumor uptake in each of 3 lesions of patient 7 obtained by ROI analysis from the dynamic PET data before (A) and after (B) therapy. Post = posterior; Mid = middle; Ant = anterior.

 


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  		FIGURE 6. (Top) Coronal and transaxial image displays containing 3 tumor sites in the pelvis (left iliac crest, the left and right sacroiliac joints) on which ROIs were drawn. (Bottom) Time–activity curves before (dashed line) and after (solid line) treatment with testosterone. The ordinate values represent an average of all 3 lesion SUVs for clarity, although all 3 tumors showed significant suppression of 18F-FDHT uptake after treatment.

 


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  		FIGURE 7. 18F-FDG and 18F-FDHT images of patient 1 before and after treatment with 17-AAG. (A and B) Corresponding coronal sections from the pretreatment 18F-FDG and 18F-FDHT scans. (C and D) Respective coronal slices after therapy. New lesions are seen on 18F-FDG and 18F-FDHT in the ilium, C3, and prostate bed. The site in the prostate bed was confirmed by biopsy.

 




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