Dietlein, Felix, Kobe, Carsten, Neubauer, Stephan, Schmidt, Matthias, Stockter, Simone, Fischer, Thomas, Schomaecker, Klaus, Heidenreich, Axel, Zlatopolskiy, Boris D., Neumaier, Bernd ORCID: 0000-0001-5425-3116, Drzezga, Alexander and Dietlein, Markus (2017). PSA-Stratified Performance of F-18- and Ga-68-PSMA PET in Patients with Biochemical Recurrence of Prostate Cancer. J. Nucl. Med., 58 (6). S. 947 - 953. RESTON: SOC NUCLEAR MEDICINE INC. ISSN 1535-5667

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Abstract

Several studies outlined the sensitivity of Ga-68-labeled PET tracers against the prostate-specific membrane antigen (PSMA) for localization of relapsed prostate cancer in patients with renewed increase in the prostate-specific antigen (PSA), commonly referred to as biochemical recurrence. Labeling of PSMA tracers with F-18 offers numerous advantages, including improved image resolution, longer half-life, and increased production yields. The aim of this study was to assess the PSA-stratified performance of the F-18-labeled PSMA tracer F-18-DCFPyL and the Ga-68-labeled reference Ga-68-PSMAHBED-CC. Methods: We examined 191 consecutive patients with biochemical recurrence according to standard acquisition protocols using F-18-DCFPyL (n = 62, 269.8 MBq, PET scan at 120 min after injection) or Ga-68-PSMA-HBED-CC (n = 129, 158.9 MBq, 60 min after injection). We determined PSA-stratified sensitivity rates for both tracers and corrected our calculations for Gleason scores using iterative matched-pair analyses. As an orthogonal validation, we directly compared tracer distribution patterns in a separate cohort of 25 patients, sequentially examined with both tracers. Results: After prostatectomy (n = 106), the sensitivity of both tracers was significantly associated with absolute PSA levels (P = 4.3 x 10(-3)). Sensitivity increased abruptly, when PSA values exceeded 0.5 mu g/L (P = 2.4 x 10(-5)). For a PSA less than 3.5 mg/L, most relapses were diagnosed at a still limited stage (P = 3.4 x 10(-6)). For a PSA of 0.5-3.5 mu g/L, PSA-stratified sensitivity was 88% (15/17) for F-18-DCFPyL and 66% (23/35) for Ga-68-PSMA-HBED-CC. This significant difference was preserved in the Gleason-matched-pair analysis. Outside of this range, sensitivity was comparably low (PSA, 0.5 mu g/L) or high (PSA. 3.5 mu g/L). After radiotherapy (n = 85), tracer sensitivity was largely PSA-independent. In the 25 patients examined with both tracers, distribution patterns of F-18-DCFPyL and Ga-68-PSMA-HBED-CC were strongly comparable (P = 2.71 x 10(-8)). However, in 36% of the PSMA-positive patients we detected additional lesions on the F-18-DCFPyL scan (P = 3.7 x 10(-2)). Conclusion: Our data suggest that F-18-DCFPyL is noninferior to Ga-68-PSMA-HBEDCC, while offering the advantages of F-18 labeling. Our results indicate that imaging with F-18-DCFPyL may even exhibit improved sensitivity in localizing relapsed tumors after prostatectomy for moderately increased PSA levels. Although the standard acquisition protocols, used for F-18-DCFPyL and Ga-68-PSMAHBED-CC in this study, stipulate different activity doses and tracer uptake times after injection, our findings provide a promising rationale for validation of F-18-DCFPyL in future prospective trials.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Dietlein, FelixUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kobe, CarstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neubauer, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schmidt, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stockter, SimoneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fischer, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schomaecker, KlausUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heidenreich, AxelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zlatopolskiy, Boris D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neumaier, BerndUNSPECIFIEDorcid.org/0000-0001-5425-3116UNSPECIFIED
Drzezga, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dietlein, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-229267
DOI: 10.2967/jnumed.116.185538
Journal or Publication Title: J. Nucl. Med.
Volume: 58
Number: 6
Page Range: S. 947 - 953
Date: 2017
Publisher: SOC NUCLEAR MEDICINE INC
Place of Publication: RESTON
ISSN: 1535-5667
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
MEMBRANE ANTIGEN; HBED-CC; INHIBITORMultiple languages
Radiology, Nuclear Medicine & Medical ImagingMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/22926

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