Universität zu Köln

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:	Creators Email ORCID ORCID Put Code Dietlein, Felix UNSPECIFIED UNSPECIFIED UNSPECIFIED Kobe, Carsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Neubauer, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Stockter, Simone UNSPECIFIED UNSPECIFIED UNSPECIFIED Fischer, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Schomaecker, Klaus UNSPECIFIED UNSPECIFIED UNSPECIFIED Heidenreich, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Zlatopolskiy, Boris D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Neumaier, Bernd UNSPECIFIED orcid.org/0000-0001-5425-3116 UNSPECIFIED Drzezga, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Dietlein, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED
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:	Keywords Language MEMBRANE ANTIGEN; HBED-CC; INHIBITOR Multiple languages Radiology, Nuclear Medicine & Medical Imaging Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/22926