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

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

doi:10.1186/s13550-020-00735-w

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

EJNMMI Res. 2021 Jan 4;11(1):2. doi: 10.1186/s13550-020-00735-w.

Authors

Dae-Myoung Yang^{1

2

3}, Fiona Li^{1

2

3}, Glenn Bauman^{3

4}, Joseph Chin^{3

4}, Stephen Pautler^{3

4}, Madeleine Moussa⁵, Irina Rachinsky³, John Valliant⁶, Ting-Yim Lee^{7

8

9

10}

Affiliations

¹ Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.
² Robarts Research Institute, University of Western Ontario, 1151 Richmond St, London, ON, N6A 5B7, Canada.
³ Lawson Health Research Institute, 268 Grosvenor St, London, ON, N6A 4V2, Canada.
⁴ Department of Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.
⁵ Pathology and Laboratory Medicine, London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada.
⁶ Centre for Probe Development and Commercialization, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
⁷ Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada. tlee@imaging.robarts.ca.
⁸ Robarts Research Institute, University of Western Ontario, 1151 Richmond St, London, ON, N6A 5B7, Canada. tlee@imaging.robarts.ca.
⁹ Lawson Health Research Institute, 268 Grosvenor St, London, ON, N6A 4V2, Canada. tlee@imaging.robarts.ca.
¹⁰ Department of Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada. tlee@imaging.robarts.ca.

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).

Keywords: Dynamic positron emission tomography (PET); Kinetic analysis; Prostate cancer; Prostate-specific membrane antigen (PSMA); [18F]DCFPyL; [18F]fluorocholine.

Associated data

ClinicalTrials.gov/NCT04009174

Grants and funding

11358/Canada Foundation for Innovation