PT  - JOURNAL ARTICLE
AU  - Fourquet, Aloÿse
AU  - Rosenberg, Adrian
AU  - Mena, Esther
AU  - Shih, Joanna J.
AU  - Turkbey, Baris
AU  - Blain, Maxime
AU  - Bergvall, Ethan
AU  - Lin, Frank
AU  - Adler, Stephen
AU  - Lim, Ilhan
AU  - Madan, Ravi A.
AU  - Karzai, Fatima
AU  - Gulley, James L.
AU  - Dahut, William L.
AU  - Wood, Bradford J.
AU  - Chang, Richard
AU  - Levy, Elliot
AU  - Choyke, Peter L.
AU  - Lindenberg, Liza
TI  - 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
AID  - 10.2967/jnumed.121.262371
DP  - 2022 May 01
TA  - Journal of Nuclear Medicine
PG  - 735--741
VI  - 63
IP  - 5
4099  - http://jnm.snmjournals.org/content/63/5/735.short
4100  - http://jnm.snmjournals.org/content/63/5/735.full
SO  - J Nucl Med2022 May 01; 63
AB  - 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.