Head-to-Head Comparison of 18F-Prostate-Specific Membrane Antigen-1007 and 18F-Fluorocholine PET/CT in Biochemically Relapsed Prostate Cancer

Abstract

Purpose of the Report The aim of the study was to prospectively compare performance of 18F-fluorocholine (FCH) and 18F-prostate-specific membrane antigen (PSMA)-1007 PET/CT in patients with biochemical relapse (BCR) of prostate cancer and low prostate-specific antigen levels. Methods We prospectively enrolled 40 BCR patients after radical treatment and prostate-specific antigen levels 2.0 ng/mL or less. 18F-FCH and 18F-PSMA-1007 PET/CT imaging was performed within a mean interval of 54 ± 21 days. Scans were done 87 ± 10 and 95 ± 12 minutes after injecting 248 ± 35 and 295 ± 14 MBq of 18F-FCH and 18F-PSMA-1007, respectively. Rates of negative, equivocal, and positive scan results were compared per patient. Per lesion, findings were grouped as equivocal or highly suggestive of malignancy and then compared for their number, localization (local relapse, lymph nodes, bones), and SUVmax values. Results Positive, equivocal, and negative results were reported in 60%, 27.5%, and 12.5% of 18F-PSMA-1007 and in 5%, 37.5%, and 57.5% of 18F-FCH scans, respectively. In 70% of scans, 18F-PSMA-1007 PET/CT upgraded 18F-FCH PET/CT results. 18F-PSMA-1007 scans also showed significantly more lesions (184 vs 63, P = 0.0006). Local relapse, lymph node, and bone lesions accounted, respectively, for 9%, 58%, and 33% of 18F-PSMA-1007 and 5%, 89%, and 6% 18F-FCH of PET/CT findings. Highly suspicious lesions accounted for 74% of 18F-PSMA-1007 and 11% of 18F-FCH PET/CT findings. In 18F-PSMA-1007 PET/CT SUVmax values of highly suggestive lesions were significantly higher than in equivocal lesions (median, 3.6 vs 2.5; P < 0.00001). Conclusions In early BCR patients 18F-PSMA-1007 showed a higher detection rate than 18F-FCH PET/CT. The former also showed more lesions in total, more highly suggestive lesions and less equivocal lesions.

The Diagnostic Role of 18F-Choline, 18F-Fluciclovine and 18F-PSMA PET/CT in the Detection of Prostate Cancer With Biochemical Recurrence: A Meta-Analysis

“…They found that PSMA PET/CT showed higher detection rates and should be the tracer choice when PET/CT imaging is considered for patients with biochemical recurrence after radical prostatectomy with low PSA concentrations (≤2.0 ng/ml). The same conclusion was drawn from another prospective study paired that compared 18 F-PSMA and 18 Ffluorocholine PET/CT in patients with BCR (42). The advantage of PSMA-targeted PET/CT imaging could be attributed to the high expression of PSMA in PCa and its metastases.…”

Comparing the diagnostic performance of radiotracers in recurrent prostate cancer: a systematic review and network meta-analysis

“…The majority of studies of retrospective design do not describe how results of the index test are interpreted separate to the reference test, pre-defined reference standards, or whether all patients were included in the analysis. Semi-quantitative standardized uptake values (SUV) were reported by only seven studies [ 4 , 26 , 28 , 30 , 31 , 33 , 34 ], and definition of uptake (SUVmax/SUVmean, thresholds and definition) was heterogeneously reported. Only one study reports diagnostic accuracy data [ 4 ], and two studies used a defined reference standard for lesion confirmation or interpretation [ 4 , 32 ].…”

Meeting report from the Prostate Cancer Foundation PSMA theranostics state of the science meeting

“…18 for 18 F-Flurocholine. 46 Lesions detected by both agents in this study had a significantly higher standardized uptake value (SUV) for 18 F-PSMA-1007 than 18 F-Flurocholine. 46 These studies support PSMA-PET imaging as superior to 18 F-labelled choline derivatives in the biochemically recurrent prostate cancer setting.…”

“…A study which directly compared 68 Ga‐PSMA‐11 vs 18 F‐Fluromethylcholine PET/CT in 38 prostate cancer patients with BCR (mean PSA 1.74 ± 2.54 ng/mL) after curative treatment demonstrated a detection rate of recurrent lesions of 66% for 68 Ga‐PSMA‐11 vs 32% for 18 F‐Fluromethylcholine 45 . A study which compared 18 F‐PSMA‐1007 vs 18 F‐Flurocholine PET/CT in 40 prostate cancer patients with a BCR (PSA <0.2 ng/mL), demonstrated a detection rate of recurrent lesions of 60% for 18 F‐PSMA‐1007 vs 5% for 18 F‐Flurocholine 46 . Lesions detected by both agents in this study had a significantly higher standardized uptake value (SUV) for 18 F‐PSMA‐1007 than 18 F‐Flurocholine 46 .…”

“…A study which compared 18 F‐PSMA‐1007 vs 18 F‐Flurocholine PET/CT in 40 prostate cancer patients with a BCR (PSA <0.2 ng/mL), demonstrated a detection rate of recurrent lesions of 60% for 18 F‐PSMA‐1007 vs 5% for 18 F‐Flurocholine 46 . Lesions detected by both agents in this study had a significantly higher standardized uptake value (SUV) for 18 F‐PSMA‐1007 than 18 F‐Flurocholine 46 . These studies support PSMA‐PET imaging as superior to 18 F‐labelled choline derivatives in the biochemically recurrent prostate cancer setting.…”