RT Journal Article
SR Electronic
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
FD Society of Nuclear Medicine
SP 735
OP 741
DO 10.2967/jnumed.121.262371
VO 63
IS 5
A1 Fourquet, Aloÿse
A1 Rosenberg, Adrian
A1 Mena, Esther
A1 Shih, Joanna J.
A1 Turkbey, Baris
A1 Blain, Maxime
A1 Bergvall, Ethan
A1 Lin, Frank
A1 Adler, Stephen
A1 Lim, Ilhan
A1 Madan, Ravi A.
A1 Karzai, Fatima
A1 Gulley, James L.
A1 Dahut, William L.
A1 Wood, Bradford J.
A1 Chang, Richard
A1 Levy, Elliot
A1 Choyke, Peter L.
A1 Lindenberg, Liza
YR 2022
UL http://jnm.snmjournals.org/content/63/5/735.abstract
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.