Characterization of primary prostate carcinoma by anti-1-amino-2-[18F] -fluorocyclobutane-1-carboxylic acid (anti-3-[18F] FACBC) uptake

• Type of Material: Article
• Authors: David M Schuster, Emory University; Pooneh A Taleghani, Emory University; Peter T Nieh, Emory University; Viraj Master, Emory University; Rianot Amzat, Emory University; Bital Savir Baruch, Emory University; Raghuveer Halkar, Emory University; Tim Fox, Emory University; Adeboye O. Osunkoya, Emory University; Carlos S Moreno, Emory University; Jonathon A Nye, Emory University; Weiping Yu, Emory University; Baowei Fei, Emory University; Zhibo Wang, Emory University; Zhengjia Chen, Emory University; Mark Goodman, Emory University
• Language: English
• Date: 2013
• Publisher: e-Century Publishing
• Publication Version: Final Published Version
• Copyright Statement: AJNMMI Copyright © 2013
• License: Creative Commons Attribution-Noncommercial 3.0 Unported
• Final Published Version (URL): http://www.ajnmmi.us/ajnmmi_V3N1.html
• Title of Journal or Parent Work: American Journal of Nuclear Medicine and Molecular Imaging
• ISSN: 2160-8407
• Volume: 3
• Issue: 1
• Start Page: 85
• End Page: 96
• Grant/Funding Information: This is work is supported by the National Institutes of Health (P 50 CA 128301), with additional support from the Georgia Cancer Coalition.
• Keywords: Positron emission tomography (PET); prostate carcinoma; anti-3-[18F] FACBC
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Anti-1-amino-3-[18F] fluorocyclobutane-1-carboxylic acid (anti-3-[18F] FACBC) is a synthetic amino acid positron emission tomography (PET) radiotracer with utility in the detection of recurrent prostate carcinoma. The aim of this study is to correlate uptake of anti-3-[18F] FACBC with histology of prostatectomy specimens in patients undergoing radical prostatectomy and to determine if uptake correlates to markers of tumor aggressiveness such as Gleason score. Ten patients with prostate carcinoma pre-radical prostatectomy underwent 45 minute dynamic PET-CT of the pelvis after IV injection of 347.8 ± 81.4 MBq anti-3-[18F] FACBC. Each prostate was co-registered to a separately acquired MR, divided into 12 sextants, and analyzed visually for abnormal focal uptake at 4, 16, 28, and 40 min post-injection by a single reader blinded to histology. SUVmax per sextant and total sextant activity (TSA) was also calculated. Histology and Gleason scores were similarly recorded by a urologic pathologist blinded to imaging. Imaging and histologic analysis were then compared. In addition, 3 representative sextants from each prostate were chosen based on highest, lowest and median SUVmax for immunohistochemical (IHC) analysis of Ki67, synaptophysin, P504s, chromogranin A, P53, androgen receptor, and prostein. 79 sextants had malignancy and 41 were benign. Highest combined sensitivity and specificity was at 28 min by visual analysis; 81.3% and 50.0% respectively. SUVmax was significantly higher (p<0.05) for malignant sextants (5.1±2.6 at 4 min; 4.5±1.6 at 16 min; 4.0±1.3 at 28 min; 3.8±1.0 at 40 min) compared to non-malignant sextants (4.0±1.9 at 4 min; 3.5±0.8 at 16 min; 3.4±0.9 at 28 min; 3.3±0.9 at 40 min), though there was overlap of activity between malignant and non-malignant sextants. SUVmax also significantly correlated (p<0.05) with Gleason score at all time points (r=0.28 at 4 min; r=0.42 at 16 min; r=0.46 at 28 min; r=0.48 at 40 min). There was no significant correlation of anti-3-[18F] FACBC SUVmax with Ki-67 or other IHC markers. Since there was no distinct separation between malignant and non-malignant sextants or between Gleason score levels, we believe that anti-3-[18F] FACBC PET should not be used alone for radiation therapy planning but may be useful to guide biopsy to the most aggressive lesion.