TY - JOUR T1 - A Comparison of <sup>18</sup>F-DCFPyL, <sup>18</sup>F-NaF, and <sup>18</sup>F-FDG PET/CT in a Prospective Cohort of Men with Metastatic Prostate Cancer JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 735 LP - 741 DO - 10.2967/jnumed.121.262371 VL - 63 IS - 5 AU - Aloÿse Fourquet AU - Adrian Rosenberg AU - Esther Mena AU - Joanna J. Shih AU - Baris Turkbey AU - Maxime Blain AU - Ethan Bergvall AU - Frank Lin AU - Stephen Adler AU - Ilhan Lim AU - Ravi A. Madan AU - Fatima Karzai AU - James L. Gulley AU - William L. Dahut AU - Bradford J. Wood AU - Richard Chang AU - Elliot Levy AU - Peter L. Choyke AU - Liza Lindenberg Y1 - 2022/05/01 UR - http://jnm.snmjournals.org/content/63/5/735.abstract N2 - 18F-DCFPyL, 18F-sodium fluoride (18F-NaF), and 18F-FDG PET/CT were compared in a prospective cohort of men with metastatic prostate cancer (PCa). Methods: Sixty-seven 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, and 6 men had no disease uptake on any of the PET/CT scans (and were subsequently excluded from the analysis). In group 1, 18F-NaF detected significantly more metastatic lesions than 18F-DCFPyL (median of 3 lesions vs. 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 castration-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 vs. 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 castration-resistant than castration-sensitive men (P = 0.048). Conclusion: 18F-DCFPyL PET/CT is the most versatile of the 3 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. These findings indicate considerable phenotypic differences among metastatic lesions. ER -