Research Papers:

A comparison of prostate cancer bone metastases on 18F-Sodium Fluoride and Prostate Specific Membrane Antigen (18F-PSMA) PET/CT: Discordant uptake in the same lesion

Stephanie A. Harmon _, Esther Mena, Joanna H. Shih, Stephen Adler, Yolanda McKinney, Ethan Bergvall, Sherif Mehralivand, Adam G. Sowalsky, Anna Couvillon, Ravi A. Madan, James L. Gulley, Janet Eary, Ronnie C. Mease, Martin G. Pomper, William L. Dahut, Baris Turkbey, Liza Lindenberg and Peter L. Choyke

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Oncotarget. 2018; 9:37676-37688. https://doi.org/10.18632/oncotarget.26481

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Stephanie A. Harmon1,2, Esther Mena2, Joanna H. Shih3, Stephen Adler1,2, Yolanda McKinney2, Ethan Bergvall2, Sherif Mehralivand2, Adam G. Sowalsky4, Anna Couvillon5, Ravi A. Madan5, James L. Gulley5, Janet Eary6, Ronnie C. Mease7, Martin G. Pomper7, William L. Dahut5, Baris Turkbey2, Liza Lindenberg2 and Peter L. Choyke2

1Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA

2Molecular Imaging Program, National Cancer Institute, NIH, Bethesda, MD, USA

3Biometric Research Branch, National Cancer Institute, NIH, Bethesda, MD, USA

4Laboratory of Genitourinary Cancer Pathogenesis, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA

5Genitourinary Malignancies Branch, National Cancer Institute, NIH, Bethesda, MD, USA

6Cancer Imaging Program, National Cancer Institute, NIH, Rockville, MD, USA

7Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Correspondence to:

Stephanie A. Harmon, email: [email protected]

Keywords: prostate cancer; bone metastases; sodium fluoride; prostate specific membrane antigen; spatial analysis

Received: October 01, 2018     Accepted: December 04, 2018     Published: December 28, 2018


Purpose: Prostate-Specific Membrane Antigen (PSMA) PET/CT has been introduced as a sensitive method for characterizing metastatic prostate cancer. The purpose of this study is to compare the spatial concordance of 18F-NaF PET/CT and 18F-PSMA-targeted PET/CT within prostate cancer bone metastases.

Methods: Prostate cancer patients with known bone metastases underwent PSMA-targeted PET/CT (18F-DCFBC or 18F-DCFPyL) and 18F-NaF PET/CT. In pelvic and spinal lesions detected by both radiotracers, regions-of-interest (ROIs) derived by various thresholds of uptake intensity were compared for spatial colocalization. Overlap volume was correlated with uptake characteristics and disease status.

Results: The study included 149 lesions in 19 patients. Qualitatively, lesions exhibited a heterogeneous range of spatial concordance between PSMA and NaF uptake from completely matched to completely discordant. Quantitatively, overlap volume decreased as a function of tracer intensity. and disease status, where lesions from patients with castration-sensitive disease showed higher spatial concordance while lesions from patients with castration-resistant disease demonstrated more frequent spatial discordance.

Conclusion: As metastatic prostate cancer progresses from castration-sensitive to castration-resistant, greater discordance is observed between NaF PET and PSMA PET uptake. This may indicate a possible phenotypic shift to tumor growth that is more independent of bone remodeling via osteoblastic formation.

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