Detection of recurrent prostate carcinoma with anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid PET/CT and 111In-capromab pendetide SPECT/CT

Abstract

Purpose: To compare the diagnostic performance of the synthetic amino acid analog radiotracer anti-1-amino-3-fluorine 18-fluorocyclobutane-1-carboxylic acid (anti-3-(18)F-FACBC) with that of indium 111 ((111)In)-capromab pendetide in the detection of recurrent prostate carcinoma.

Materials and methods: This prospective study was approved by the institutional review board and complied with HIPAA guidelines. Written informed consent was obtained. Fifty patients (mean age, 68.3 years ± 8.1 [standard deviation]; age range, 50-90 years) were included in the study on the basis of the following criteria: (a) Recurrence of prostate carcinoma was suspected after definitive therapy for localized disease, (b) bone scans were negative, and (c) anti-3-(18)F-FACBC positron emission tomography (PET)/computed tomography (CT) and (111)In-capromab pendetide single photon emission computed tomography (SPECT)/CT were performed within 6 weeks of each other. Studies were evaluated by two experienced interpreters for abnormal uptake suspicious for recurrent disease in the prostate bed and extraprostatic locations. The reference standard was a combination of tissue correlation, imaging, laboratory, and clinical data. Diagnostic performance measures were calculated and tests of the statistical significance of differences determined by using the McNemar χ(2) test as well as approximate tests based on the difference between two proportions.

Results: For disease detection in the prostate bed, anti-3-(18)F-FACBC had a sensitivity of 89% (32 of 36 patients; 95% confidence interval [CI]: 74%, 97%), specificity of 67% (eight of 12 patients; 95% CI: 35%, 90%), and accuracy of 83% (40 of 48 patients; 95% CI: 70%, 93%). (111)In-capromab pendetide had a sensitivity of 69% (25 of 36 patients; 95% CI: 52%, 84%), specificity of 58% (seven of 12 patients; 95% CI: 28%, 85%), and accuracy of 67% (32 of 48 patients; 95% CI: 52%, 80%). In the detection of extraprostatic recurrence, anti-3-(18)F-FACBC had a sensitivity of 100% (10 of 10 patients; 95% CI: 69%, 100%), specificity of 100% (seven of seven patients; 95% CI: 59%, 100%), and accuracy of 100% (17 of 17 patients; 95% CI: 80%, 100%). (111)In-capromab pendetide had a sensitivity of 10% (one of 10 patients; 95% CI: 0%, 45%), specificity of 100% (seven of seven patients; 95% CI: 59%, 100%), and accuracy of 47% (eight of 17 patients; 95% CI: 23%, 72%).

Conclusion: anti-3-(18)F-FACBC PET/CT was more sensitive than (111)In-capromab pendetide SPECT/CT in the detection of recurrent prostate carcinoma and is highly accurate in the differentiation of prostatic from extraprostatic disease.

Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11102023/-/DC1.

Figure 1:

Flow diagram of study patients and results obtained for disease in the prostatic bed with ¹¹¹In–capromab pendetide and anti-3-¹⁸F-FACBC.

Figure 2a:

Images in a patient who had undergone radical prostatectomy (PSA level, 16.9 ng/mL). (a) Sagittal PET and (b) fused PET/CT scans obtained with anti-3-¹⁸F-FACBC. (c) SPECT and (d) fused SPECT/CT scans obtained with ¹¹¹In–capromab pendetide. Images were fused to same CT scan. Intense uptake between bladder base and rectum on scans obtained with anti-3-¹⁸F-FACBC (arrow in a and b) corresponded to biopsy-proved recurrence. No uptake is seen in same region on images obtained with ¹¹¹In–capromab pendetide (arrow in c and d). This is an example of a true-positive finding with anti-3-¹⁸F-FACBC and a false-negative finding with ¹¹¹In–capromab pendetide. Note bladder and rectal activity on ¹¹¹In–capromab pendetide images (arrowheads in c and d).

Figure 2b:

Images in a patient who had undergone radical prostatectomy (PSA level, 16.9 ng/mL). (a) Sagittal PET and (b) fused PET/CT scans obtained with anti-3-¹⁸F-FACBC. (c) SPECT and (d) fused SPECT/CT scans obtained with ¹¹¹In–capromab pendetide. Images were fused to same CT scan. Intense uptake between bladder base and rectum on scans obtained with anti-3-¹⁸F-FACBC (arrow in a and b) corresponded to biopsy-proved recurrence. No uptake is seen in same region on images obtained with ¹¹¹In–capromab pendetide (arrow in c and d). This is an example of a true-positive finding with anti-3-¹⁸F-FACBC and a false-negative finding with ¹¹¹In–capromab pendetide. Note bladder and rectal activity on ¹¹¹In–capromab pendetide images (arrowheads in c and d).

Figure 2c:

Images in a patient who had undergone radical prostatectomy (PSA level, 16.9 ng/mL). (a) Sagittal PET and (b) fused PET/CT scans obtained with anti-3-¹⁸F-FACBC. (c) SPECT and (d) fused SPECT/CT scans obtained with ¹¹¹In–capromab pendetide. Images were fused to same CT scan. Intense uptake between bladder base and rectum on scans obtained with anti-3-¹⁸F-FACBC (arrow in a and b) corresponded to biopsy-proved recurrence. No uptake is seen in same region on images obtained with ¹¹¹In–capromab pendetide (arrow in c and d). This is an example of a true-positive finding with anti-3-¹⁸F-FACBC and a false-negative finding with ¹¹¹In–capromab pendetide. Note bladder and rectal activity on ¹¹¹In–capromab pendetide images (arrowheads in c and d).

Figure 2d:

Images in a patient who had undergone radical prostatectomy (PSA level, 16.9 ng/mL). (a) Sagittal PET and (b) fused PET/CT scans obtained with anti-3-¹⁸F-FACBC. (c) SPECT and (d) fused SPECT/CT scans obtained with ¹¹¹In–capromab pendetide. Images were fused to same CT scan. Intense uptake between bladder base and rectum on scans obtained with anti-3-¹⁸F-FACBC (arrow in a and b) corresponded to biopsy-proved recurrence. No uptake is seen in same region on images obtained with ¹¹¹In–capromab pendetide (arrow in c and d). This is an example of a true-positive finding with anti-3-¹⁸F-FACBC and a false-negative finding with ¹¹¹In–capromab pendetide. Note bladder and rectal activity on ¹¹¹In–capromab pendetide images (arrowheads in c and d).

Figure 3:

Flow diagram of study patients and results obtained for extraprostatic disease with ¹¹¹In–capromab pendetide and anti-3-¹⁸F-FACBC.

Figure 4a:

Images in a patient who had undergone radical prostatectomy (PSA level, 1.1 ng/mL). (a) Transverse PET and (b) fused PET/CT scans obtained with anti-3-¹⁸F-FACBC. (c) SPECT and (d) fused SPECT/CT scans obtained with ¹¹¹In–capromab pendetide. Intense uptake on images obtained with anti-3-¹⁸F-FACBC (arrow in a and b) corresponded to a 5-mm recurrence in the left obturator lymph node, which was proved at biopsy. There is no uptake in same region on images obtained with ¹¹¹In–capromab pendetide (arrow in c and d). This is an example of a true-positive finding with anti-3-¹⁸F-FACBC and a false-negative finding with ¹¹¹In–capromab pendetide.

Figure 4b:

Images in a patient who had undergone radical prostatectomy (PSA level, 1.1 ng/mL). (a) Transverse PET and (b) fused PET/CT scans obtained with anti-3-¹⁸F-FACBC. (c) SPECT and (d) fused SPECT/CT scans obtained with ¹¹¹In–capromab pendetide. Intense uptake on images obtained with anti-3-¹⁸F-FACBC (arrow in a and b) corresponded to a 5-mm recurrence in the left obturator lymph node, which was proved at biopsy. There is no uptake in same region on images obtained with ¹¹¹In–capromab pendetide (arrow in c and d). This is an example of a true-positive finding with anti-3-¹⁸F-FACBC and a false-negative finding with ¹¹¹In–capromab pendetide.

Figure 4c:

Images in a patient who had undergone radical prostatectomy (PSA level, 1.1 ng/mL). (a) Transverse PET and (b) fused PET/CT scans obtained with anti-3-¹⁸F-FACBC. (c) SPECT and (d) fused SPECT/CT scans obtained with ¹¹¹In–capromab pendetide. Intense uptake on images obtained with anti-3-¹⁸F-FACBC (arrow in a and b) corresponded to a 5-mm recurrence in the left obturator lymph node, which was proved at biopsy. There is no uptake in same region on images obtained with ¹¹¹In–capromab pendetide (arrow in c and d). This is an example of a true-positive finding with anti-3-¹⁸F-FACBC and a false-negative finding with ¹¹¹In–capromab pendetide.

Figure 4d:

Images in a patient who had undergone radical prostatectomy (PSA level, 1.1 ng/mL). (a) Transverse PET and (b) fused PET/CT scans obtained with anti-3-¹⁸F-FACBC. (c) SPECT and (d) fused SPECT/CT scans obtained with ¹¹¹In–capromab pendetide. Intense uptake on images obtained with anti-3-¹⁸F-FACBC (arrow in a and b) corresponded to a 5-mm recurrence in the left obturator lymph node, which was proved at biopsy. There is no uptake in same region on images obtained with ¹¹¹In–capromab pendetide (arrow in c and d). This is an example of a true-positive finding with anti-3-¹⁸F-FACBC and a false-negative finding with ¹¹¹In–capromab pendetide.

Figure 5a:

Images in a patient who had undergone radical prostatectomy (PSA level, 2.97 ng/mL). (a) Transverse PET and (b) fused PET/CT scans obtained with anti-3-¹⁸F-FACBC. (c) SPECT and (d) fused SPECT/CT scans obtained with ¹¹¹In–capromab pendetide. Intense uptake on images obtained with anti-3-¹⁸F-FACBC (arrow in a and b) corresponded to a subtle lytic bone lesion in the right pubic ramus, which was proved as recurrence at biopsy. There is no uptake in same region on images obtained with ¹¹¹In–capromab pendetide (arrow in c and d). This is an example of a true-positive finding with anti-3-¹⁸F-FACBC and a false-negative finding with ¹¹¹In–capromab pendetide.

Figure 5b:

Images in a patient who had undergone radical prostatectomy (PSA level, 2.97 ng/mL). (a) Transverse PET and (b) fused PET/CT scans obtained with anti-3-¹⁸F-FACBC. (c) SPECT and (d) fused SPECT/CT scans obtained with ¹¹¹In–capromab pendetide. Intense uptake on images obtained with anti-3-¹⁸F-FACBC (arrow in a and b) corresponded to a subtle lytic bone lesion in the right pubic ramus, which was proved as recurrence at biopsy. There is no uptake in same region on images obtained with ¹¹¹In–capromab pendetide (arrow in c and d). This is an example of a true-positive finding with anti-3-¹⁸F-FACBC and a false-negative finding with ¹¹¹In–capromab pendetide.

Figure 5c:

Images in a patient who had undergone radical prostatectomy (PSA level, 2.97 ng/mL). (a) Transverse PET and (b) fused PET/CT scans obtained with anti-3-¹⁸F-FACBC. (c) SPECT and (d) fused SPECT/CT scans obtained with ¹¹¹In–capromab pendetide. Intense uptake on images obtained with anti-3-¹⁸F-FACBC (arrow in a and b) corresponded to a subtle lytic bone lesion in the right pubic ramus, which was proved as recurrence at biopsy. There is no uptake in same region on images obtained with ¹¹¹In–capromab pendetide (arrow in c and d). This is an example of a true-positive finding with anti-3-¹⁸F-FACBC and a false-negative finding with ¹¹¹In–capromab pendetide.

Figure 5d:

Images in a patient who had undergone radical prostatectomy (PSA level, 2.97 ng/mL). (a) Transverse PET and (b) fused PET/CT scans obtained with anti-3-¹⁸F-FACBC. (c) SPECT and (d) fused SPECT/CT scans obtained with ¹¹¹In–capromab pendetide. Intense uptake on images obtained with anti-3-¹⁸F-FACBC (arrow in a and b) corresponded to a subtle lytic bone lesion in the right pubic ramus, which was proved as recurrence at biopsy. There is no uptake in same region on images obtained with ¹¹¹In–capromab pendetide (arrow in c and d). This is an example of a true-positive finding with anti-3-¹⁸F-FACBC and a false-negative finding with ¹¹¹In–capromab pendetide.