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. 2022 May;63(5):735-741.
doi: 10.2967/jnumed.121.262371. Epub 2021 Sep 2.

A Comparison of 18F-DCFPyL, 18F-NaF, and 18F-FDG PET/CT in a Prospective Cohort of Men with Metastatic Prostate Cancer

Aloÿse Fourquet  1 , Adrian Rosenberg  1 , Esther Mena  1 , Joanna J Shih  2 , Baris Turkbey  1 , Maxime Blain  3 , Ethan Bergvall  1 , Frank Lin  1 , Stephen Adler  4 , Ilhan Lim  5 , Ravi A Madan  6 , Fatima Karzai  6 , James L Gulley  6 , William L Dahut  6 , Bradford J Wood  3 , Richard Chang  3 , Elliot Levy  3 , Peter L Choyke  1 , Liza Lindenberg  7   8
Affiliations

A Comparison of 18F-DCFPyL, 18F-NaF, and 18F-FDG PET/CT in a Prospective Cohort of Men with Metastatic Prostate Cancer

Aloÿse Fourquet et al. J Nucl Med. 2022 May.

Abstract

18F-DCFPyL, 18F-sodium fluoride (18F-NaF), and 18F-FDG PET/CT were compared in a prospective cohort of men with metastatic prostate cancer (PCa). Methods: Sixty-seven men (group 1) with documented metastatic PCa underwent 18F-DCFPyL and 18F-NaF PET/CT and a subgroup of 30 men (group 2) underwent additional imaging with 18F-FDG PET/CT. The tracers were compared for their detection rates, imaging concordance, associations with prostate-specific antigen (PSA), treatment at the time of imaging, and castration status. Results: Overall, 61 men had metastatic disease detected on one or more scans, and 6 men had no disease uptake on any of the PET/CT scans (and were subsequently excluded from the analysis). In group 1, 18F-NaF detected significantly more metastatic lesions than 18F-DCFPyL (median of 3 lesions vs. 2, P = 0.001) even after eliminating benign causes of 18F-NaF uptake. This difference was particularly clear for men receiving treatment (P = 0.005) or who were castration-resistant (P = 0.014). The median percentage of bone lesions that were concordant on 18F-DCFPyL and 18F-NaF was 50%. In group 2, 18F-DCFPyL detected more lesions than 18F-FDG (median of 5 lesions vs. 2, P = 0.0003), regardless of PSA level, castration status, or treatment. The median percentage of lesions that were concordant on 18F-DCFPyL and 18F-FDG was 22.2%. This percentage was slightly higher for castration-resistant than castration-sensitive men (P = 0.048). Conclusion:18F-DCFPyL PET/CT is the most versatile of the 3 PET agents for metastatic PCa; however, 18F-NaF detects more bone metastases. Imaging reveals substantial tumor heterogeneity with only 50% concordance between 18F-DCFPyL and 18F-NaF and 22% concordance for 18F-DCFPyL and 18F-FDG. These findings indicate considerable phenotypic differences among metastatic lesions.

Keywords: FDG; NaF; PSMA; metastatic; prostate cancer.

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Figures

None
Graphical abstract
FIGURE 1.
FIGURE 1.
Lesion number comparisons.
FIGURE 2.
FIGURE 2.
18F-DCFPyL (left) and 18F-NaF (right) discordance. A 61-y-old man with metastatic PCa involving lymph nodes and bones. PSA at imaging was 49.69 ng/mL. More bone lesions were seen with 18F-NaF than with 18F-DCFPyL (arrows).
FIGURE 3.
FIGURE 3.
Number of lesions detected by 18F-DCFPyL (A), 18F-NaF (B), and 18F-FDG (C) according to median PSA (left), treatment at the time of imaging (middle), and castration status (right).
FIGURE 4.
FIGURE 4.
Comparison of median number of lesions detected by 18F-NaF and 18F-DCFPyL (bone lesions only) (A) and by 18F-FDG and 18F-DCFPyL (B) according to median PSA (left), treatment at the time of imaging (middle), and castration status.
FIGURE 5.
FIGURE 5.
Concordant PET metastases. A 64-y-old man with metastatic CRPC. PSA at imaging was 464 ng/mL. Concordant pathologic foci were noted on all scans at T8 vertebral body and left iliac bone, consistent with metastasis.
See this image and copyright information in PMC

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