Diagnostic Performance of [18F]AlF-Thretide PET/CT in Patients with Newly Diagnosed Prostate Cancer Using Histopathology as Reference Standard

Jie Zang; Yun Yang; Shaoming Chen; Chao Wang; Shaohao Chen; Shun Hu; Hai Cai; Xiaodong Li; Ning Xu; Xiaoyuan Chen; Jingjing Zhang; Weibing Miao

doi:10.2967/jnumed.123.266940

Diagnostic Performance of [¹⁸F]AlF-Thretide PET/CT in Patients with Newly Diagnosed Prostate Cancer Using Histopathology as Reference Standard

J Nucl Med. 2024 Jul 1;65(7):1021-1026. doi: 10.2967/jnumed.123.266940.

Authors

Jie Zang^{1

2}, Yun Yang^{1

2}, Shaoming Chen^{1

2}, Chao Wang^{1

2}, Shaohao Chen³, Shun Hu⁴, Hai Cai³, Xiaodong Li³, Ning Xu³, Xiaoyuan Chen^{5

6

7

8

9}, Jingjing Zhang^{10

6

7}, Weibing Miao^{11

2

12}

Affiliations

¹ Department of Nuclear Medicine, First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
² Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
³ Department of Urology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
⁴ Department of Pathology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
⁵ Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁶ Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁷ Nanomedicine Translational Research Program, NUS Center for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁸ Department of Chemical and Biomolecular Engineering and Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, Singapore.
⁹ Institute of Molecular and Cell Biology, Agency for Science, Technology, and Research, Proteos, Singapore, Singapore; and.
¹⁰ Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; miaoweibing@126.com j.zhang@nus.edu.sg.
¹¹ Department of Nuclear Medicine, First Affiliated Hospital, Fujian Medical University, Fuzhou, China; miaoweibing@126.com j.zhang@nus.edu.sg.
¹² Fujian Key Laboratory of Precision Medicine for Cancer, First Affiliated Hospital, Fujian Medical University, Fuzhou, China.

PMID: 38724276
DOI: 10.2967/jnumed.123.266940

Abstract

This study aimed to assess the diagnostic value of [¹⁸F]AlF-thretide PET/CT in patients with newly diagnosed prostate cancer (PCa). Methods: In total, 49 patients with biopsy-proven PCa were enrolled in this prospective study. All patients underwent [¹⁸F]AlF-thretide PET/CT, and the scoring system of the PRIMARY trial was used for PET image analysis. The dosimetry evaluation of [¹⁸F]AlF-thretide was performed on 3 patients. Pathologic examination was used as the reference standard to evaluate the location, number, size, and Gleason score of tumors, for comparison with the [¹⁸F]AlF-thretide PET/CT results. PSMA expression was evaluated by immunohistochemical staining. Results: All patients tolerated the [¹⁸F]AlF-thretide PET/CT well. The total effective dose of [¹⁸F]AlF-thretide was 1.16E-02 mSv/MBq. For patient-based analysis of intraprostatic tumors, 46 of 49 (93.9%) patients showed pathologic uptake on [¹⁸F]AlF-thretide PET/CT. For lesion-based analysis of intraprostatic tumors, the sensitivity and positive predictive value for [¹⁸F]AlF-thretide PET/CT were 58.2% and 90.5%, respectively. Delayed images can detect more lesions than standard images (n = 57 vs. 49, P = 0.005), and the SUV_max and tumor-to-background ratio of the former were higher than those of the latter (SUV_max: 14.5 ± 16.7 vs. 11.4 ± 13.6, P < 0.001; tumor-to-background ratio: 37.1 ± 42.3 vs. 23.1 ± 27.4, P < 0.001). The receiver-operating-characteristic curve analysis showed that the areas under the curve for PRIMARY score-predicted true-positive and false-positive lesions were significantly higher than those for the SUV_max of standard images (P = 0.015) and seemed higher than those for the SUV_max of delayed images (P = 0.257). [¹⁸F]AlF-thretide PET/CT showed a higher detection rate than multiparametric MRI for all intraprostatic foci (53.5% vs. 40.8%, P = 0.012) and clinically significant PCa (75.0% vs. 61.4%, P = 0.031). Conclusion: [¹⁸F]AlF-thretide PET/CT showed high diagnostic value for patients with primary PCa and can be used as an excellent imaging modality for preoperative evaluation of PCa patients.

Keywords: PRIMARY score; [18F]AlF-thretide; mpMRI; prostate cancer.

MeSH terms

Aged
Aged, 80 and over
Fluorine Radioisotopes
Humans
Male
Middle Aged
Positron Emission Tomography Computed Tomography*
Prospective Studies
Prostatic Neoplasms* / diagnostic imaging
Prostatic Neoplasms* / pathology
Radiopharmaceuticals
Reference Standards

Substances

Fluorine Radioisotopes
Radiopharmaceuticals