TY - JOUR T1 - A Prospective Comparison of <sup>18</sup>F-Sodium Fluoride PET/CT and PSMA-Targeted <sup>18</sup>F-DCFBC PET/CT in Metastatic Prostate Cancer JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 1665 LP - 1671 DO - 10.2967/jnumed.117.207373 VL - 59 IS - 11 AU - Stephanie A. Harmon AU - Ethan Bergvall AU - Esther Mena AU - Joanna H. Shih AU - Stephen Adler AU - Yolanda McKinney AU - Sherif Mehralivand AU - Deborah E. Citrin AU - Anna Couvillon AU - Ravi A. Madan AU - James L. Gulley AU - Ronnie C. Mease AU - Paula M. Jacobs AU - Martin G. Pomper AU - Baris Turkbey AU - Peter L. Choyke AU - M. Liza Lindenberg Y1 - 2018/11/01 UR - http://jnm.snmjournals.org/content/59/11/1665.abstract N2 - The purpose of this study was to compare the diagnostic performance of 18F-DCFBC PET/CT, a first-generation 18F-labeled prostate-specific membrane antigen (PSMA)–targeted agent, and 18F-NaF PET/CT, a sensitive marker of osteoblastic activity, in a prospective cohort of patients with metastatic prostate cancer. Methods: Twenty-eight prostate cancer patients with metastatic disease on conventional imaging prospectively received up to 4 PET/CT scans. All patients completed baseline 18F-DCFBC PET/CT and 18F-NaF PET/CT scans, and 23 patients completed follow-up imaging, with a median follow-up interval of 5.7 mo (range, 4.2–12.6 mo). Lesion detection was compared across the 2 PET/CT agents at each time point. Detection and SUV characteristics of each PET/CT agent were compared with serum prostate-specific antigen (PSA) levels and treatment status at the time of baseline imaging using nonparametric statistical testing (Spearman correlation, Wilcoxon rank). Results: Twenty-six patients had metastatic disease detected on 18F-NaF or 18F-DCFBC at baseline, and 2 patients were negative on both scans. Three patients demonstrated soft tissue–only disease. Of 241 lesions detected at baseline, 56 were soft-tissue lesions identified by 18F-DCFBC only and 185 bone lesions detected on 18F-NaF or 18F-DCFBC. 18F-NaF detected significantly more bone lesions than 18F-DCFBC (P &lt; 0.001). Correlation of PSA with patient-level SUV metrics was strong in 18F-DCFBC (ρ &gt; 0.5, P &lt; 0.01) and poor in 18F-NaF (ρ &lt; 0.3, P &gt; 0.1). When PSA levels were combined with treatment status, patients with below-median levels of PSA (&lt;2 ng/mL) on androgen deprivation therapy (n = 11) demonstrated more lesions on 18F-NaF than 18F-DCFBC (P = 0.02). In PSA greater than 2 ng/mL, patients on androgen deprivation therapy (n = 8) showed equal to or more lesions on 18F-DCFBC than on 18F-NaF. Conclusion: The utility of PSMA-targeting imaging in metastatic prostate cancer appears to depend on patient disease course and treatment status. Compared with 18F-NaF PET/CT, 18F-DCFBC PET/CT detected significantly fewer bone lesions in the setting of early or metastatic castrate-sensitive disease on treatment. However, in advanced metastatic castrate-resistant prostate cancer, 18F-DCFBC PET/CT shows good concordance with NaF PET/CT. ER -