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A Pilot Study of Dynamic 18F-DCFPyL PET/CT Imaging of Prostate Adenocarcinoma in High-Risk Primary Prostate Cancer Patients

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Abstract

Purpose

The primary aim of this study was to investigate the pharmacokinetics of 18F-DCFPyL, an 18F-labeled PSMA-based ligand, and to explore the utility of early time point positron emission tomography (PET) imaging extracted from PET data to distinguish malignant primary prostate from benign prostate tissue.

Procedures

Ten consecutive patients with biopsy-proven high-risk prostate cancer underwent a dynamic 18F-DCFPyL PET/CT scan of the pelvis for the first 45 min post-injection (p.i.) followed by a static PET/CT at 2 h p.i. 18F-DCFPyL uptake values and kinetics were compared between benign prostate tissue and prostate cancer, including quantitative pharmacokinetic PET parameters extracted from 18F-DCFPyL time activity curves generated from dynamic data using a two-tissue compartment model and Patlak plots.

Results

18F-DCFPyL uptake values were significantly higher in primary prostate tumors than those in benign prostatic hyperplasia (BPH) and normal prostate tissue at 5 min, 30 min, and 120 min p.i. (P = 0.0002), when examining both SUVmax and SUVmean values. The two-tissue compartment model found an overall influx value (Ki) of 0.063 in primary prostate cancer, demonstrating a Ki over 15-fold higher in malignant prostate tissue compared with BPH (Ki = 0.004) and normal prostate tissue (Ki = 0.005) (P = 0.0001).

Conclusion

High-risk primary prostate cancer is readily identified on dynamic and static, delayed, 18F-DCFPyL PET images. The tumor-to-background ratio increases over time, with optimal 18F-DCFPyL PET/CT imaging at 120 min p.i. for evaluation of prostate cancer, but not necessarily ideal for clinical application. Primary prostate cancer demonstrates different uptake kinetics in comparison to BPH and normal prostate tissue. The 15-fold difference in Ki between prostate cancer and non-cancer (BPH and normal) tissues translates to an ability to distinguish prostate cancer from normal tissue at time points as early as 5 to 10 min p.i.

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Acknowledgements

We thank Gary Griffiths of the NCI/Molecular Imaging Branch for improving the readability and making other corrections to the text. We would like to further acknowledge Jean Logan, Ph.D., from the NYU School of Medicine for her input into our two-tissue compartment modeling analysis and Janet F. Eary, MD, from the NCI Cancer Imaging Program for her review of the manuscript.

Funding

This project has been funded in whole or in part with federal funds from the National Cancer Institute, National Institutes of Health, under contract No. 75N91019D00024, Task Order No. 75N91019F00129. The content of this publication does not necessarily reflect the views of policies of the Department of Health and Human services, nor does mention of trade names, commercial products, or organization imply endorsement by the U.S. Government.

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Authors and Affiliations

  1. Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA

    Michelle Lu, Liza Lindenberg, Esther Mena, Baris Turkbey, Anita Ton, Yolanda McKinney, Philip Eclarinal & Peter Choyke

  2. Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA

    Jurgen Seidel & Stephen Adler

  3. Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA

    Maria Merino

  4. Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA

    Peter Pinto

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  1. Michelle Lu
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  2. Liza Lindenberg
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  3. Esther Mena
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Contributions

All authors contributed substantially to the conception or design of the work, the acquisition, analysis, or interpretation of data for the work presented herein. All authors reviewed and revised it critically for important intellectual content. All authors are accountable for all aspects of the work and have ensured the integrity of the content presented herein.

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Correspondence to Stephen Adler.

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Lu, M., Lindenberg, L., Mena, E. et al. A Pilot Study of Dynamic 18F-DCFPyL PET/CT Imaging of Prostate Adenocarcinoma in High-Risk Primary Prostate Cancer Patients. Mol Imaging Biol 24, 444–452 (2022). https://doi.org/10.1007/s11307-021-01670-5

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  • DOI: https://doi.org/10.1007/s11307-021-01670-5

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