Imaging of metastatic clear cell renal cell carcinoma with PSMA-targeted ¹⁸F-DCFPyL PET/CT

Ann Nucl Med. 2015 Dec;29(10):877-82. doi: 10.1007/s12149-015-1017-z. Epub 2015 Aug 19.


Objective: Molecular imaging with positron emission tomography (PET) provides a powerful means of identifying and characterizing cancerous processes, as well as providing a quantitative framework within which response to therapy can be ascertained. Unfortunately, the most commonly used PET radiotracer, ¹⁸F-fluorodeoxyglucose (FDG), has not demonstrated a definitive role in determining response to therapy in metastatic renal cell carcinoma (RCC). As a result, new radiotracers able to reliably image RCC could be of tremendous value for this purpose.

Methods: Five patients with known metastatic RCC were imaged with the low-molecular weight radiotracer ¹⁸F-DCFPyL, an inhibitor of the prostate-specific membrane antigen at 60 min post injection. ¹⁸F-DCFPyL PET/CT and conventional images (either contrast-enhanced computed tomography or magnetic resonance imaging) were centrally reviewed for suspected sites of disease.

Results: In all five patients imaged, sites of putative metastatic disease were readily identifiable by abnormal ¹⁸F-DCFPyL uptake, with overall more lesions detected than on conventional imaging. These PET-detected sites included lymph nodes, pancreatic parenchymal lesions, lung parenchymal lesions, a brain parenchymal lesion, and other soft tissue sites. ¹⁸F-DCFPyL uptake ranged from subtle to intense with maximum standardized uptake values (SUVmax) for the identified lesions of 1.6-19.3. Based upon this small patient series, limited pathology and imaging follow-up of these patients suggests a higher sensitivity for ¹⁸F-DCFPyL compared to conventional imaging in the detection of metastatic RCC (94.7 versus 78.9%).

Conclusions: PSMA expression in the tumor neovasculature of RCC has been previously established and is believed to provide the basis for the imaging findings presented here. PSMA-based PET/CT with radiotracers such as ¹⁸F-DCFPyL may allow more accurate staging of patients with RCC and conceivably the ability to predict and follow therapy in patients treated with agents targeting the neovasculature.

Keywords: DCFPyL; Positron emission tomography (PET); Prostate-specific membrane antigen (PSMA); Renal cell carcinoma (RCC).

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Antigens, Surface / metabolism*
  • Carcinoma, Renal Cell / diagnosis*
  • Carcinoma, Renal Cell / diagnostic imaging
  • Carcinoma, Renal Cell / pathology
  • Glutamate Carboxypeptidase II / metabolism*
  • Humans
  • Kidney Neoplasms / diagnosis*
  • Kidney Neoplasms / diagnostic imaging
  • Kidney Neoplasms / pathology
  • Lysine / analogs & derivatives*
  • Male
  • Middle Aged
  • Multimodal Imaging*
  • Neoplasm Metastasis
  • Positron-Emission Tomography*
  • Tomography, X-Ray Computed*
  • Urea / analogs & derivatives*


  • 2-(3-(1-carboxy-5-((6-fluoropyridine-3-carbonyl)amino)pentyl)ureido)pentanedioic acid
  • Antigens, Surface
  • Urea
  • FOLH1 protein, human
  • Glutamate Carboxypeptidase II
  • Lysine