18F-DCFBC PET/CT for PSMA-based Detection and Characterization of Primary Prostate Cancer (original) (raw)
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18F-DCFBC PET/CT for PSMA-Based Detection and Characterization of Primary Prostate Cancer
The Journal of Nuclear Medicine, 2015
We previously demonstrated the ability to detect metastatic prostate cancer using N-[N-[(S)-1,3-dicarboxypropyl]carbamoyl]-4-18 F-fluorobenzyl-L-cysteine (18 F-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 riskadapted patient management. Methods: We enrolled 13 patients with primary prostate cancer who were imaged with 18 F-DCFBC PET before scheduled prostatectomy, with 12 of these patients also undergoing pelvic prostate MR imaging. Prostate 18 F-DCFBC PET was correlated with MR imaging and histologic and immunohistochemical analysis on a prostate-segment (12 regions) and dominantlesion basis. There were no incidental extraprostatic findings on PET suggestive of metastatic disease. Results: MR imaging was more sensitive than 18 F-DCFBC PET for detection of primary prostate cancer on a per-segment (sensitivities of up to 0.17 and 0.39 for PET and MR imaging, respectively) and per-dominant-lesion analysis (sensitivities of 0.46 and 0.92 for PET and MR imaging, respectively). However, 18 F-DCFBC PET was more specific than MR imaging by per-segment analysis (specificities of 0.96 and 0.89 for PET and MR imaging for corresponding sensitivity, respectively) and specific for detection of high-grade lesions (Gleason 8 and 9) greater than 1.0 mL in size (4/4 of these patients positive by PET). 18 F-DCFBC uptake in tumors was positively correlated with Gleason score (r 5 0.64; PSMA expression, r 5 0.47; and prostate-specific antigen, r 5 0.52). There was significantly lower 18 F-DCFBC uptake in benign prostatic hypertrophy than primary tumors (median maximum standardized uptake value, 2.2 vs. 3.5; P 5 0.004). Conclusion: Although the sensitivity of 18 F-DCFBC for primary prostate cancer was less than MR imaging, 18 F-DCFBC PET was able to detect the more clinically significant high-grade and larger-volume tumors (Gleason score 8 and 9) with higher specificity than MR imaging. In particular, there was relatively low 18 F-DCFBC PET uptake in benign prostatic hypertrophy lesions, compared with cancer in the prostate, which may allow for more specific detection of primary prostate cancer by 18 F-DCFBC PET. This study demonstrates the utility of PSMA-based PET, which may be used in conjunction with MR imaging to identify clinically significant prostate cancer.
Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging, 2016
Current standard of care conventional imaging modalities (CIM) such as X-ray computed tomography (CT) and bone scan can be limited for detection of metastatic prostate cancer and therefore improved imaging methods are an unmet clinical need. We evaluated the utility of a novel second-generation low molecular weight radiofluorinated prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) radiotracer, [(18)F]DCFPyL, in patients with metastatic prostate cancer. Nine patients with suspected prostate cancer recurrence, eight with CIM evidence of metastatic prostate cancer and one with biochemical recurrence, were imaged with [(18)F]DCFPyL PET/CT. Eight of the patients had contemporaneous CIM for comparison. A lesion-by-lesion comparison of the detection of suspected sites of metastatic prostate cancer was carried out between PET and CIM. Statistical analysis for estimated proportions of inter-modality agreement for detection of metastatic disease was calcula...
Clinical perspectives of PSMA PET/MRI for prostate cancer
Clinics (Sao Paulo, Brazil), 2018
Prostate cancer imaging has become an important diagnostic modality for tumor evaluation. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) has been extensively studied, and the results are robust and promising. The advent of the PET/magnetic resonance imaging (MRI) has added morphofunctional information from the standard of reference MRI to highly accurate molecular information from PET. Different PSMA ligands have been used for this purpose including 68gallium and 18fluorine-labeled PET probes, which have particular features including spatial resolution, imaging quality and tracer biodistribution. The use of PSMA PET imaging is well established for evaluating biochemical recurrence, even at low prostate-specific antigen (PSA) levels, but has also shown interesting applications for tumor detection, primary staging, assessment of therapeutic responses and treatment planning. This review will outline the potential role of PSMA PET/MRI for the clinical asses...
Prostate Cancer and Prostatic Diseases, 2020
Background PSMA-PET is a novel imaging modality for the staging of prostate cancer (PCa). While there are several PSMA ligands available, F-18-PSMA-1007 is particularly of interest as it is not renally excreted and therefore does not impair the imaging of the pelvic area. Hence, this study aimed to investigate the F-18-PSMA-1007-PET for the primary staging of PCa and compared it to multi-parametric (mp) MRI and histopathology. Methods A retrospective study was performed of men with intermediate and high-risk PCa patients that underwent a F-18-PSMA-1007-PET after mpMRI with subsequent MR-guided target biopsy (MRGB). Suspicious mpMRI lesions and F-18-PSMA-1007-PET were simultaneously reviewed on both a per patient and per-lesion basis. Results were subsequently evaluated with histopathological outcome of MRGB, and if performed, the radical prostatectomy specimen. Results A total of 66 suspicious mpMRI lesions were identified in 53 patients and underwent MRGB. Two lesions had a maximum standardized uptake value (SUV max) less than the mean SUV max of healthy prostate tissue and were considered as non-PSMA-expressing. All PSMA avid tumors had higher SUV max than the mean SUV mean of the bladder/urine, therefore all lesions were clearly distinguishable in the pelvic area. Twenty-three patients received a radical prostatectomy of which the histopathology specimens were evaluated. F-18-PSMA-1007-PET/CT correctly staged seminal vesicle invasion (i.e. pT3b) more often than mpMRI (90 vs. 76%), whereas mpMRI more accurately detected extracapsular extension (i.e. pT3a) compared to F-18-PSMA-1007-PET (90% vs 57%). Conclusions The present study of a selected cohort suggest that dual imaging with mpMRI and F-18-PSMA-1007-PET may improve staging of primary PCa. F-18-PSMA-1007-PET/CT had low renal clearance, which could assist the evaluation of tumors in proximity of the bladder.
Cancers
Prostate-specific membrane antigen (PSMA) PET use in prostate cancer treatment has recently become a routinely used imaging modality by urologists. New, established data regarding its performance in different stages of prostate cancer, as well as gaining clinical knowledge with new tracers, drives the need for urologists and other clinicians to improve the utilization of this tool. While the use of PSMA PET/CT is more common in metastatic disease, in which it outperforms classical imaging modalities and drives treatment decisions and adjustments, recently, it gained ground in localized prostate cancer as well, especially in high-risk disease. Still, PSMA PET/CT might reveal lesions within the prostate or possibly locoregional or metastatic disease, not always representing true cancer when utilized in earlier stages of the disease, potentially adding diagnostic burden and changing treatment decisions. As urological treatment options advance toward focal treatments in localized organ-...
68Ga-PSMA PET/CT and PET/MRI in high-risk prostate cancer patients
Nuclear Medicine Communications, 2018
Treatment of high-risk prostate cancer (HRPCa) is challenging. Local staging and metastatic evaluation are important for the patient management. Recently, prostatespecific membrane antigen (PSMA)-based imaging modalities such as PSMA PET/CT and PET/MRI have received significant attention for detection of recurrent prostate cancer sites with elevated prostate-specific antigen levels, after therapy. Current evidence suggests that these imaging modalities may also have a role for the management of patients with HRPCa. In this review, we discuss PSMA-based imaging modalities in the management of patients with HRPCa. Nucl Med Commun
American Journal of Roentgenology, 2018
In recent years, on the basis of initial clinical results, 68 Ga-prostate-specific membrane antigen (PSMA)-HBED-CC has emerged with high diagnostic accuracy for prostate cancer imaging [4]. Both digital rectal examination (DRE) and prostate-specific antigen (PSA) testing are the two key components of the clinical evaluation of the prostate gland [5]. The limitations of PSA level as a biomarker for prostate cancer are well known. Routine use of PSA level as a screening tool followed by transrectal ultrasound-guided (TRUS) biopsy has resulted in increased detection of prostate cancer with the identification of low-risk disease [6]. However, the outcome of the procedures is associated with overdiagnosis and
PSMA Ligand PET/MRI for Primary Prostate Cancer: Staging Performance and Clinical Impact
Clinical cancer research : an official journal of the American Association for Cancer Research, 2018
Primary staging of prostate cancer relies on modalities, which are limited. We evaluate simultaneous [Ga]Ga-PSMA-11 PET (PSMA-PET)/MRI as a new diagnostic method for primary tumor-node-metastasis staging compared with histology and its impact on therapeutic decisions. We investigated 122 patients with PSMA-PET/MRI prior to planned radical prostatectomy (RP). Primary endpoint was the accuracy of PSMA-PET/MRI in tumor staging as compared with staging-relevant histology. In addition, a multidisciplinary team reassessed the initial therapeutic approach to evaluate its impact on the therapeutic management. PSMA-PET/MRI correctly identified prostate cancer in 119 of 122 patients (97.5%). Eighty-one patients were treated with RP and pelvic lymphadenectomy. The accuracy for T staging was 82.5% [95% confidence interval (CI), 73-90; < 0.001], for T2 stage was 85% (95% CI, 71-94; < 0.001), for T3a stage was 79% (95% CI, 43-85; < 0.001), for T3b stage was 94% (95% CI, 73-100; < 0.00...
The Journal of Urology, 2018
, we selected those who performed an early scan for the detection of prostate fossae recurrences and had a PSA levels <2 ng/mL at PET time. 75 subjects met the inclusion criteria. All these patients underwent an early static (after 2 minutes from the FCH injection; 1 bed; 5 minutes/bed) and late whole-body (after 60 minutes from FCH injection; 7 beds; 3 minutes/ bed) PET/CT acquisition. A correlation among terapeutic factors, Gleason Score, PSA levels, PSA doubling time (PSAdt), PSA velocity (PSA vel) and early PET/CT findings were assessed by using the chisquare test and Mann-Whitney test. The agreement between early and late PET/CT acquisitions was studied by K-statistic. ROC analysis was used to evaluate the optimal cutoff point for PSA able to distinguish positive and negative PET/CT finding. A p<0.05 was considered statistically significant. RESULTS: PET/CT showed a pathological tracer uptake in 25 patients (33.3%); in 15 cases confined to the prostatic bed, in 4 to lymph nodes, in 4 to the bone, in 2 to both prostatic fossae and lymph nodes and in 3 to both bone and lymph nodes. Therefore, the detection rate of PET/CT was higher for local recurrences (18/25; 72%). PSA values increased in patients with a positive PET/CT finding compared to subjects with a negative scan. Similarly, PSAdt and PSAvel values were different between patients with a positive and a negative PET/CT scan (6.9 versus 10.2 mo and 0.6 versus 0.4 ng/mL/year, respectively). 15 patients had positive early scans and only 4/15 were positive for both early and late PET/CT acquisition (Kappa value ¼ 0.368; p< 0.001). No correlation was found between the PSAdt or PSAvel and positive or negative early PET/CT images. At ROC analysis a PSA value of 0.67 ng/mL showed a sensitivity and specificity of 69% and 64%, respectively, to distinguish patients with positive or negative PET findings. Using this cutoff value, FCH PET/CT was positive in 23% of patients with PSA < 0.67 ng/mL; 12% of patients had a positive early PET/CT and therefore 88% had negative early scans. CONCLUSIONS: From this study emerges that, in patients with PSA < 2 ng/mL, local recurrence is more often detect by FCH PET/CT finding. An early PET acquisition is able to improve the detection rate, expecially in prostatic fossae, and we reported in this study that local findings were increased to 70%. Our results suggest that the selection of patients ungergoing a "dual phase" PET/CT should be based not only on PSA value but also on PSA kinetic.