PT - JOURNAL ARTICLE AU - Steven P Rowe AU - Kenneth L Gage AU - Sheila F Faraj AU - Katarzyna Macura AU - Toby C Cornish AU - Nilda Gonzalez-Roibon AU - Guner Gunes AU - Enrico Munari AU - Alan W Partin AU - Christian P Pavlovich AU - Misop Han AU - H Ballentine Carter AU - Trinity J Bivalacqua AU - Amanda Blackford AU - Daniel Holt AU - Robert F Dannals AU - George J Netto AU - Martin Lodge AU - Ronnie C Mease AU - Martin G Pomper AU - Steve Y Cho TI - <sup>18</sup>F-DCFBC PET/CT for PSMA-based Detection and Characterization of Primary Prostate Cancer AID - 10.2967/jnumed.115.154336 DP - 2015 Jun 01 TA - Journal of Nuclear Medicine PG - jnumed.115.154336 4099 - http://jnm.snmjournals.org/content/early/2015/06/10/jnumed.115.154336.short 4100 - http://jnm.snmjournals.org/content/early/2015/06/10/jnumed.115.154336.full AB - We previously demonstrated the ability to detect metastatic prostate cancer using 18F-DCFBC (DCFBC), a low-molecular-weight radiotracer that targets the prostate-specific membrane antigen (PSMA). PSMA has been shown to be associated with higher Gleason grade and more aggressive disease. An imaging biomarker able to detect clinically significant high-grade primary prostate cancer reliably would address an unmet clinical need by allowing for risk-adapted patient management. Methods: We enrolled 13 patients with primary prostate cancer who were imaged with DCFBC PET prior to scheduled prostatectomy, with 12 of these patients also undergoing pelvic prostate MRI. Prostate DCFBC PET was correlated with MRI and histological and immunohistochemical (IHC) analysis on a prostate segment (12 regions) and dominant lesion basis. There were no incidental extraprostatic findings on PET suspicious for metastatic disease. Results: MRI was more sensitive than DCFBC PET for detection of primary prostate cancer on a per-segment (sensitivities of 0.17 and 0.39 for PET and MRI for non-stringent analysis and 0.10 and 0.35 for stringent analysis, respectively) and per-dominant lesion analysis (sensitivity of 0.46 and 0.92 for PET and MRI, respectively). However, DCFBC PET was more specific than MRI by per-segment analysis (specificity of 0.96 and 0.89 for PET and MRI for non-stringent analysis and 1.00 versus 0.91 for stringent analysis, respectively) and highly specific for detection of high-grade lesions greater than or equal to 1.1 mL in size (Gleason 8 and 9). DCFBC uptake in tumors was positively correlated with Gleason score (ρ = 0.64, PSMA expression (ρ = 0.47) and PSA (ρ = 0.52). There was significantly lower DCFBC uptake in benign prostatic hypertrophy (BPH) compared to primary tumors (median SUVmax 2.2 versus SUVmax 3.5; P = 0.004). Conclusion: Although the sensitivity of DCFBC for primary prostate cancer was less than MRI, DCFBC PET was able to detect the more clinically significant high-grade tumors (Gleason score 8 and 9) with higher specificity than MRI. In particular, there was relatively low DCFBC PET uptake in BPH lesions compared to cancer in the prostate, which may allow for more specific detection of primary prostate cancer by DCFBC PET. This study demonstrates the utility of PSMA-based PET for detection of primary prostate cancer, which may be used in conjunction with MRI to guide biopsy and identify clinically significant, aggressive disease non-invasively.