Anti-3-[(18)F]FACBC positron emission tomography-computerized tomography and (111)In-capromab pendetide single photon emission computerized tomography-computerized tomography for recurrent prostate carcinoma: results of a prospective clinical trial

Abstract

Purpose: We prospectively evaluated the amino acid analogue positron emission tomography radiotracer anti-3-[(18)F]FACBC compared to ProstaScint® ((111)In-capromab pendetide) single photon emission computerized tomography-computerized tomography to detect recurrent prostate carcinoma.

Materials and methods: A total of 93 patients met study inclusion criteria who underwent anti-3-[(18)F]FACBC positron emission tomography-computerized tomography plus (111)In-capromab pendetide single photon emission computerized tomography-computerized tomography for suspected recurrent prostate carcinoma within 90 days. Reference standards were applied by a multidisciplinary board. We calculated diagnostic performance for detecting disease.

Results: In the 91 of 93 patients with sufficient data for a consensus on the presence or absence of prostate/bed disease anti-3-[(18)F]FACBC had 90.2% sensitivity, 40.0% specificity, 73.6% accuracy, 75.3% positive predictive value and 66.7% negative predictive value compared to (111)In-capromab pendetide with 67.2%, 56.7%, 63.7%, 75.9% and 45.9%, respectively. In the 70 of 93 patients with a consensus on the presence or absence of extraprostatic disease anti-3-[(18)F]FACBC had 55.0% sensitivity, 96.7% specificity, 72.9% accuracy, 95.7% positive predictive value and 61.7% negative predictive value compared to (111)In-capromab pendetide with 10.0%, 86.7%, 42.9%, 50.0% and 41.9%, respectively. Of 77 index lesions used to prove positivity histological proof was obtained in 74 (96.1%). Anti-3-[(18)F]FACBC identified 14 more positive prostate bed recurrences (55 vs 41) and 18 more patients with extraprostatic involvement (22 vs 4). Anti-3-[(18)F]FACBC positron emission tomography-computerized tomography correctly up-staged 18 of 70 cases (25.7%) in which there was a consensus on the presence or absence of extraprostatic involvement.

Conclusions: Better diagnostic performance was noted for anti-3-[(18)F]FACBC positron emission tomography-computerized tomography than for (111)In-capromab pendetide single photon emission computerized tomography-computerized tomography for prostate carcinoma recurrence. The former method detected significantly more prostatic and extraprostatic disease.

Keywords: 1-amino-3-fluorocyclobutane-1-carboxylic acid; capromab pendetide; emission-computed; photon; positron-emission tomography; prostatic neoplasms; tomography.

Figure 1

Imaging in 80-year-old patient after external beam radiotherapy, cryotherapy and brachytherapy with increasing PSA to 1.6 ng/ml and biopsy positive prostate bed. ¹¹¹In-capromab pendetide CT (A), scintigraphy (B) and fused image (C ) show no significant uptake in prostate bed over background but note abnormal uptake in right posterior bed using anti-3-[¹⁸F]FACBC on CT (D), PET (E ) and fused PET-CT (F ). Biopsy specimen section shows Gleason score 4 + 5 = 9 prostatic adenocarcinoma invading adipose tissue with extraprostatic extension (G). H&E, reduced from ×20.

Figure 2

Imaging in 65-year-old patient after external beam radiation therapy and cryotherapy with increasing PSA to 13.8 ng/ml and biopsy negative prostate bed with metastasis confirmed by laparoscopic biopsy in small left common iliac node. ¹¹¹In-capromab pendetide CT (A), scintigraphy (B) and fused image (C ) show no uptake in 0.7 × 1.1 cm left common iliac node but note abnormal uptake using anti-3-[¹⁸F]FACBC on CT (D), PET (E ) and fused PET-CT (F ). Stained lymph node section shows metastatic prostate adenocarcinoma (G). H&E, reduced from ×40.

Figure 3

Imaging in 61-year-old patient after external beam radiation therapy and hormonal therapy with increasing PSA to 1.96 ng/ml reveals extensive biopsy proven recurrent disease in prostate and multiple pelvic nodes. ¹¹¹In-capromab pendetide CT (A), scintigraphy (B) and fused image (C ) show abnormal uptake in prostate and left perirectal node. Anti-3-[¹⁸F]FACBC CT (D), PET (E ) and fused image (F ) at same level also show abnormal uptake in prostate and left perirectal node. Prostate core biopsy demonstrates prostatic Gleason 4 + 4 = 8 adenocarcinoma (G). H&E, reduced from × 10. Fine needle aspiration of perirectal node demonstrates malignant prostate adenocarcinoma cells with glandular formation and prominent nucleoli (H ). ¹¹¹In-capromab pendetide findings were considered abnormal in node but there was better lesion contrast on anti-3-[¹⁸F]FACBC imaging with more nodes identified in pelvis. Diff-Quik stain, reduced from ×40.