18F-DCFBC Prostate-Specific Membrane Antigen-Targeted PET/CT Imaging in Localized Prostate Cancer: Correlation With Multiparametric MRI and Histopathology.

Abstract

PURPOSE:

To assess the ability of (N-[N-[(S)-1,3-dicarboxypropyl]carbamoyl]-4-F-fluorobenzyl-L-cysteine) (F-DCFBC), a prostate-specific membrane antigen-targeted PET agent, to detect localized prostate cancer lesions in correlation with multiparametric MRI (mpMRI) and histopathology.

METHODS:

This Health Insurance Portability and Accountability Act of 1996-compliant, prospective, institutional review board-approved study included 13 evaluable patients with localized prostate cancer (median age, 62.8 years [range, 51-74 years]; median prostate-specific antigen, 37.5 ng/dL [range, 3.26-216 ng/dL]). Patients underwent mpMRI and F-DCFBC PET/CT within a 3 months' window. Lesions seen on mpMRI were biopsied under transrectal ultrasound/MRI fusion-guided biopsy, or a radical prostatectomy was performed. F-DCFBC PET/CT and mpMRI were evaluated blinded and separately for tumor detection on a lesion basis. For PET image analysis, MRI and F-DCFBC PET images were fused by using software registration; imaging findings were correlated with histology, and uptake of F-DCFBC in tumors was compared with uptake in benign prostatic hyperplasia nodules and normal peripheral zone tissue using the 80% threshold SUVmax.

RESULTS:

A total of 25 tumor foci (mean size, 1.8 cm; median size, 1.5 cm; range, 0.6-4.7 cm) were histopathologically identified in 13 patients. Sensitivity rates of F-DCFBC PET/CT and mpMRI were 36% and 96%, respectively, for all tumors. For index lesions, the largest tumor with highest Gleason score, sensitivity rates of F-DCFBC PET/CT and mpMRI were 61.5% and 92%, respectively. The average SUVmax for primary prostate cancer was higher (5.8 ± 4.4) than that of benign prostatic hyperplasia nodules (2.1 ± 0.3) or that of normal prostate tissue (2.1 ± 0.4) at 1 hour postinjection (P = 0.0033).

CONCLUSIONS:

The majority of index prostate cancers are detected with F-DCFBC PET/CT, and this may be a prognostic indicator based on uptake and staging. However, for detecting prostate cancer with high sensitivity, it is important to combine prostate-specific membrane antigen PET/CT with mpMRI.

• Authors: Baris Turkbey, Esther Mena, Liza Lindenberg, Stephen Adler, Sandra Bednarova, Rose Berman, Anita T Ton, Yolanda McKinney, Philip Eclarinal, Craig Hill, George Afari, Sibaprasad Bhattacharyya, Ronnie C Mease, Maria J Merino, Paula M Jacobs, Bradford J Wood, Peter A Pinto, Martin G Pomper, Peter L Choyke
• Journal: Clinical nuclear medicine (Clin Nucl Med) Vol. 42 Issue 10 Pg. 735-740 (Oct 2017) ISSN: 1536-0229 [Electronic] United States
• PMID: 28806263 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Antigens, Surface
• N-(N-((S)-1,3-Dicarboxypropyl)carbamoyl)-4-(18F)fluorobenzyl-L-cysteine
• FOLH1 protein, human
• Glutamate Carboxypeptidase II
• Cysteine

Topics

• Aged
• Antigens, Surface (metabolism)
• Cysteine (analogs & derivatives)
• Glutamate Carboxypeptidase II (metabolism)
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Positron Emission Tomography Computed Tomography
• Prospective Studies
• Prostatectomy
• Prostatic Neoplasms (diagnostic imaging, metabolism, pathology, surgery)