PT  - JOURNAL ARTICLE
AU  - Rowe, Steven P.
AU  - Macura, Katarzyna J.
AU  - Ciarallo, Anthony
AU  - Mena, Esther
AU  - Blackford, Amanda
AU  - Nadal, Rosa
AU  - Antonarakis, Emmanuel S.
AU  - Eisenberger, Mario A.
AU  - Carducci, Michael A.
AU  - Ross, Ashley E.
AU  - Kantoff, Philip W.
AU  - Holt, Daniel P.
AU  - Dannals, Robert F.
AU  - Mease, Ronnie C.
AU  - Pomper, Martin G.
AU  - Cho, Steve Y.
TI  - Comparison of Prostate-Specific Membrane Antigen–Based <sup>18</sup>F-DCFBC PET/CT to Conventional Imaging Modalities for Detection of Hormone-Naïve and Castration-Resistant Metastatic Prostate Cancer
AID  - 10.2967/jnumed.115.163782
DP  - 2016 Jan 01
TA  - Journal of Nuclear Medicine
PG  - 46--53
VI  - 57
IP  - 1
4099  - http://jnm.snmjournals.org/content/57/1/46.short
4100  - http://jnm.snmjournals.org/content/57/1/46.full
SO  - J Nucl Med2016 Jan 01; 57
AB  - Conventional imaging modalities (CIMs) have limited sensitivity and specificity for detection of metastatic prostate cancer. We examined the potential of a first-in-class radiofluorinated small-molecule inhibitor of prostate-specific membrane antigen (PSMA), N-[N-[(S)-1,3-dicarboxypropyl]carbamoyl]-4-18F-fluorobenzyl-l-cysteine (18F-DCFBC), to detect metastatic hormone-naïve (HNPC) and castration-resistant prostate cancer (CRPC). Methods: Seventeen patients were prospectively enrolled (9 HNPC and 8 CRPC); 16 had CIM evidence of new or progressive metastatic prostate cancer and 1 had high clinical suspicion of metastatic disease. 18F-DCFBC PET/CT imaging was obtained with 2 successive PET scans starting at 2 h after injection. Patients were imaged with CIM at approximately the time of PET. A lesion-by-lesion analysis of PET to CIM was performed in the context of either HNPC or CRPC. The patients were followed with available clinical imaging as a reference standard to determine the true nature of identified lesions on PET and CIM. Results: On the lesion-by-lesion analysis, 18F-DCFBC PET was able to detect a larger number of lesions (592 positive with 63 equivocal) than CIM (520 positive with 61 equivocal) overall, in both HNPC and CRPC patients. 18F-DCFBC PET detection of lymph nodes, bone lesions, and visceral lesions was superior to CIM. When intrapatient clustering effects were considered, 18F-DCFBC PET was estimated to be positive in a large proportion of lesions that would be negative or equivocal on CIM (0.45). On follow-up, the sensitivity of 18F-DCFBC PET (0.92) was superior to CIM (0.71). 18F-DCFBC tumor uptake was increased at the later PET time point (∼2.5 h after injection), with background uptake showing a decreasing trend on later PET. Conclusion: PET imaging with 18F-DCFBC, a small-molecule PSMA-targeted radiotracer, detected more lesions than CIM and promises to diagnose and stage patients with metastatic prostate cancer more accurately than current imaging methods.