Research ArticleClinical Investigations

Prospective Comparison of 18F-Fluoromethylcholine Versus 68Ga-PSMA PET/CT in Prostate Cancer Patients Who Have Rising PSA After Curative Treatment and Are Being Considered for Targeted Therapy

Joshua J. Morigi, Phillip D. Stricker, Pim J. van Leeuwen, Reuben Tang, Bao Ho, Quoc Nguyen, George Hruby, Gerald Fogarty, Raj Jagavkar, Andrew Kneebone, Adam Hickey, Stefano Fanti, Lisa Tarlinton and Louise Emmett
Journal of Nuclear Medicine August 2015, 56 (8) 1185-1190; DOI: https://doi.org/10.2967/jnumed.115.160382

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Total number of lesions detected for each patient with 18F-fluoromethylcholine (FMC) and 68Ga-PSMA, ranked by ascending PSA value.

  • FIGURE 2.
    FIGURE 2.

    Total number of 18F-fluoromethylcholine (FMC) and 68Ga-PSMA–positive lesions per anatomic site, including prostate bed or seminal vesicles (local), bone, or lymph nodes.

  • FIGURE 3.
    FIGURE 3.

    A 70-y-old man with Gleason 7 prostate cancer treated with radiation therapy who presented with rising PSA level (8.9) and PSA doubling time of 9.5 mo. 18F-fluoromethylcholine (FMC) scan was negative, whereas 68Ga-PSMA scan demonstrated intense uptake in prostate (maximum standardized uptake value, 4.5). Subsequent biopsy confirmed local recurrence.

  • FIGURE 4.
    FIGURE 4.

    Impact on management. FMC = 18F-fluoromethylcholine.

  • FIGURE 5.
    FIGURE 5.

    A 62-y-old man with Gleason 7 prostate cancer treated with radical prostatectomy and salvage radiation who presented with rising PSA level (0.4) and PSA doubling time of 8 mo. 18F-fluoromethylcholine (FMC) PET/CT findings were negative, whereas 68Ga-PSMA PET/CT scan demonstrated single positive left obturator lymph node (maximum standardized uptake value, 3.7). Subsequent biopsy confirmed prostate cancer recurrence.

  • FIGURE 6.
    FIGURE 6.

    A 70-y-old man with Gleason 7 prostate cancer treated with radical prostatectomy who presented with rising PSA (12.0) and PSA doubling time of 5.8 mo. Both 18F-fluoromethylcholine (FMC) PET/CT and 68Ga-PSMA PET/CT were positive for nodal disease (4 lesions positive on 18F-fluoromethylcholine imaging and 9 on 68Ga-PSMA). However, TBR was higher for 68Ga-PSMA than for 18F-fluoromethylcholine (25.0 vs. 7.0 in this image of positive paracaval lymph node). Biopsy confirmed nodal recurrence of prostate cancer.

Tables

  • TABLE 1

    Patient Characteristics and Preimaging Data

    CharacteristicData
    Age (y)
     Mean68
     Range54–81
    PSA at time of scan (ng/dL)
     Mean ± SD1.72 ± 2.54
     Range0.04–12.0
    PSA doubling time (mo)
     Mean ± SD15.6 ± 22.1
     Range2.6–111.2
    Initial treatment (n)
     Radical prostatectomy34/38 (89%)
     Radiotherapy*4/38 (11%)
     Surgery + salvage radiotherapy12/38 (32%)
     PSA at diagnosis (ng/dL)
      Mean ± SD9.7 ± 4.9
      Range2.8–20.2
     Years since diagnosis
     Mean7
     Range1–18
    Gleason score (n)
     6–723/38 (61%)
     8–915/38 (39%)
    Risk group† (n)
     Intermediate11/38 (24%)
     High27/38 (76%)

    • ↵* External-beam radiation therapy or brachytherapy.

    • ↵† According to European Association of Urology guidelines.

  • TABLE 2

    Detection Rates of 18F-Fluoromethylcholine and 68Ga-PSMA

    PSA level (ng/mL)18F-fluoromethylcholine68Ga-PSMAP
    <0.512.5% (2/16)50% (8/16)0.03
    0.5–2.036% (5/14)71% (10/14)0.02
    >2.063% (5/8)88% (7/8)0.18
    Total32% (12/38)66% (25/38)<0.001
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