Research ArticleClinical Investigations

Prospective Study Evaluating Na18F PET/CT in Predicting Clinical Outcomes and Survival in Advanced Prostate Cancer

Andrea B. Apolo, Liza Lindenberg, Joanna H. Shih, Esther Mena, Joseph W. Kim, Jong C. Park, Anna Alikhani, Yolanda Y. McKinney, Juanita Weaver, Baris Turkbey, Howard L. Parnes, Lauren V. Wood, Ravi A. Madan, James L. Gulley, William L. Dahut, Karen A. Kurdziel and Peter L. Choyke
Journal of Nuclear Medicine June 2016, 57 (6) 886-892; DOI: https://doi.org/10.2967/jnumed.115.166512

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    (A) Progressive disease on Na18F PET/CT in 67-y-old man with postdocetaxel metastatic castration-resistant prostate cancer whose PSA level increased on treatment with abiraterone acetate (6 mo) and cabazitaxel (12 mo). Sequential Na18F PET/CT scans detected multiple new skeletal lesions. Image intensities were equally adjusted. (B) Improved disease on Na18F PET/CT in 66-y-old man with metastatic castration-resistant prostate cancer who had PSA response to docetaxel chemotherapy. Sequential Na18F PET/CT scans showed significant decrease in uptake in right pelvic skeletal lesion. Image intensities were equally adjusted.

  • FIGURE 2.
    FIGURE 2.

    Number of lesions on Na18F PET/CT vs. 99mTc-BS.

  • FIGURE 3.
    FIGURE 3.

    99mTc-BS and Na18F PET/CT in 74-y-old man with high-risk prostate cancer. 99mTc-BS shows right rib lesions categorized as indeterminate (blue arrows). Na18F PET/CT confirms lesions as malignant and shows additional malignant lesions in skull, ribs, and pelvis (red arrows). Other uptake (green arrow) is consistent with degenerative change. MDP = methylene diphosphonate.

  • FIGURE 4.
    FIGURE 4.

    Incidental finding of fibrous dysplasia on Na18F PET/CT. Right nasal bone appears characteristically opaque and expansile. Left image is axial CT scan of skull in bone window; right image is frontal maximum-intensity-projection Na18F PET/CT scan of skull.

Tables

  • TABLE 1

    Patient Demographics and Clinical Characteristics

    Known bone metastases at enrollment
    CharacteristicNegative (n = 30)Positive (n = 30)
    Age (y)
     Median6564.5
     Range43–7944–79
    Baseline PSA (ng/mL)
     Median10.979.93
     Range0.01–1900.1–593
    Gleason score
     41 (3%)0
     64 (13%)3 (10%)
     77 (23%)10 (33%)
     88 (27%)5 (17%)
     99 (30%)11 (37%)
     1001 (3%)
    On treatment at NIH
     Yes6 (20%)11 (37%)
     No24 (80%)19 (63%)
    Managed at NIH multidisciplinary clinic
     Yes10 (33%)2 (7%)
     No20 (66%)28 (93%)
    Primary therapy
     Radical prostatectomy14 (47%)13 (43%)
     External-beam radiation8 (26%)7 (23%)
     Brachytherapy2 (7%)0
    Castration status
     Sensitive21 (70%)13 (43%)
     Resistant9 (30%)17 (57%)
    Therapy while on study
     GnRH agonist/antagonist (leuprorelin/degarelix)2826
     Antiandrogen (bicalutamide, nilutamide)1413
     Ketoconazole14
     Enzalutamide01
     Abiraterone01
     Docetaxel, bevacizumab, lenalidomide, prednisone010
     Taxane02
     Bisphosphonate (zoledronic acid/dasatinib)36
     Sipuleucel-T03
     Vaccine study (TARP, Prostvac [Bavarian Nordic])34
     TRC105 (TRACON Pharmaceuticals)11
     Radiation44

    • NIH = National Institutes of Health; GnRH = gonadotropin-releasing hormone; TARP, T-cell receptor γ alternate reading frame protein.

    • Total number of patients is 60. Data are number of patients, unless otherwise indicated.

  • TABLE 2

    Distribution of Malignant Bone Metastases on Na18F PET/CT

    LocationScans with ≥1 lesion
    Skull19 (13%)
    Spine34 (24%)
    Pelvic bones40 (28%)
    Thorax34 (24%)
    Long bones15 (11%)
    Superscan8
  • TABLE 3

    Number of Na18F PET/CT Lesions with Respect to Clinical Impression at Each Time Point

    Time pointDataP
    BaselineArm 1, 5 (0–52)Arm 2, 0 (0–4)<0.0001
    Clinical impression at 6 moImproved, 3 (0–29)Stable, 2 (0–24)Progressed, 14 (2–65)0.0078
    Clinical impression at 12 moImproved, 6 (1–29)Stable, 1 (0–26)Progressed, 25 (0–59)0.0029

    • Total number of lesions is 60. Data are median number of lesions, followed by range in parentheses.

  • TABLE 4

    Detection of Lesions by Na18F PET/CT and 99mTc-BS in Patient-Based Analysis

    99mTc-BS
    Na18F PET/CTPositiveIndeterminateNegative
    Positive37146
    Indeterminate030
    Negative125

    • Total number of scans is 68.

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