RT Journal Article SR Electronic T1 A comparison of 18F-DCFPyL, 18F-NaF and 18F-FDG PET/CT in a prospective cohort of men with metastatic prostate cancer JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP jnumed.121.262371 DO 10.2967/jnumed.121.262371 A1 Aloÿse Fourquet A1 Adrian Rosenberg A1 Esther Mena A1 Joanna J. Shih A1 Baris Turkbey A1 Maxime Blain A1 Ethan Bergvall A1 Frank I Lin A1 Stephen Adler A1 Ilhan Lim A1 Ravi A Madan A1 Fatima Karzai A1 James L. Gulley A1 William L. Dahut A1 Bradford J. Wood A1 Richard Chang A1 Elliot Levy A1 Peter L. Choyke A1 Liza Lindenberg YR 2021 UL http://jnm.snmjournals.org/content/early/2021/09/02/jnumed.121.262371.abstract AB Introduction: 18F-DCFPyL, 18F-NaF and 18F-FDG PET/CT were compared in a prospective cohort of men with metastatic prostate cancer (PCa). Materials and Methods: 67 men (Group 1) with documented metastatic PCa underwent 18F-DCFPyL and 18F-NaF PET/CT and a subgroup of 30 men (Group 2) underwent additional imaging with 18F-FDG PET/CT. The tracers were compared for their detection rates, imaging concordance, associations with Prostate Specific Antigen (PSA), treatment at the time of imaging and castration status. Results: Overall, 61 men had metastatic disease detected on one or more scans, while 6 men were negative. In Group 1, 18F-NaF detected significantly more metastatic lesions than 18F-DCFPyL (median of 3 lesions versus 2, P = 0.001) even after eliminating benign causes of 18F-NaF uptake. This difference was particularly clear for men receiving treatment (P = 0.005) or who were castrate resistant (P = 0.014). The median percentage of bone lesions that were concordant on 18F-DCFPyL and 18F-NaF was 50%. In Group 2, 18F-DCFPyL detected more lesions than 18F-FDG (median of 5 lesions versus 2, P = 0.0003), regardless of PSA level, castration status or treatment. The median percentage of lesions that were concordant on 18F-DCFPyL and 18F-FDG was 22.2%. This percentage was slightly higher for castrate-resistant than castrate-sensitive men (P = 0.048). Conclusion: 18F-DCFPyL PET/CT is the most versatile of the three PET agents for metastatic PCa however, 18F-NaF detects more bone metastases. Imaging reveals substantial tumor heterogeneity with only 50% concordance between 18F-DCFPyL and 18F-NaF and 22% concordance for 18F-DCFPyL and 18F-FDG. This indicates considerable phenotypic differences among metastatic lesions.