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Open Access 01-12-2021 | Prostate Cancer | Original research

Kinetic analysis of dominant intraprostatic lesion of prostate cancer using quantitative dynamic [¹⁸F]DCFPyL-PET: comparison to [¹⁸F]fluorocholine-PET

Authors: Dae-Myoung Yang, Fiona Li, Glenn Bauman, Joseph Chin, Stephen Pautler, Madeleine Moussa, Irina Rachinsky, John Valliant, Ting-Yim Lee

Published in: EJNMMI Research | Issue 1/2021

Abstract

Purpose

Identification of the dominant intraprostatic lesion(s) (DILs) can facilitate diagnosis and treatment by targeting biologically significant intra-prostatic foci. A PSMA ligand, [¹⁸F]DCFPyL (2-(3-{1-carboxy-5-[(6-[¹⁸F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid), is better than choline-based [¹⁸F]FCH (fluorocholine) in detecting and localizing DIL because of higher tumour contrast, particularly when imaging is delayed to 1 h post-injection. The goal of this study was to investigate whether the different imaging performance of [¹⁸F]FCH and [¹⁸F]DCFPyL can be explained by their kinetic behaviour in prostate cancer (PCa) and to evaluate whether DIL can be accurately detected and localized using a short duration dynamic positron emission tomography (PET).

Methods

19 and 23 PCa patients were evaluated with dynamic [¹⁸F]DCFPyL and [¹⁸F]FCH PET, respectively. The dynamic imaging protocol with each tracer had a total imaging time of 22 min and consisted of multiple frames with acquisition times from 10 to 180 s. Tumour and benign tissue regions identified by sextant biopsy were compared using standardized uptake value (SUV) and tracer kinetic parameters from kinetic analysis of time-activity curves.

Results

For [¹⁸F]DCFPyL, logistic regression identified K_i and k₄ as the optimal model to discriminate tumour from benign tissue (84.2% sensitivity and 94.7% specificity), while only SUV was predictive for [¹⁸F]FCH (82.6% sensitivity and 87.0% specificity). The higher k₃ (binding) of [¹⁸F]FCH than [¹⁸F]DCFPyL explains why [¹⁸F]FCH SUV can differentiate tumour from benign tissue within minutes of injection. Superior [¹⁸F]DCFPyL tumour contrast was due to the higher k₄/k₃ (more rapid washout) in benign tissue compared to tumour tissue.

Conclusions

DIL was detected with good sensitivity and specificity using 22-min dynamic [¹⁸F]DCFPyL PET and avoids the need for delayed post-injection imaging timepoints. The dissimilar in vivo kinetic behaviour of [¹⁸F]DCFPyL and [¹⁸F]FCH could explain their different SUV images.

Clinical Trial Registration NCT04009174 (ClinicalTrials.gov).

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Title: Kinetic analysis of dominant intraprostatic lesion of prostate cancer using quantitative dynamic [18F]DCFPyL-PET: comparison to [18F]fluorocholine-PET
Authors: Dae-Myoung Yang
Fiona Li
Glenn Bauman
Joseph Chin
Stephen Pautler
Madeleine Moussa
Irina Rachinsky
John Valliant
Ting-Yim Lee
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Prostate Cancer
Positron Emission Tomography
Published in: EJNMMI Research / Issue 1/2021
Electronic ISSN: 2191-219X
DOI: https://doi.org/10.1186/s13550-020-00735-w

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Kinetic analysis of dominant intraprostatic lesion of prostate cancer using quantitative dynamic [¹⁸F]DCFPyL-PET: comparison to [¹⁸F]fluorocholine-PET

Abstract

Purpose

Methods

Results

Conclusions

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