18F-DCFPyL PET/CT in High Risk and Recurrent Prostate Cancer

Background:

• Prostate cancer (PCa) is the second leading cause of cancer death in American males.
• Patients with high risk but apparently localized disease are often understaged because disease beyond the prostate is not well detected and thus leads to overtreatment with prostatectomy
• Recurrence of PCa after surgery or radiation is very common and sometimes progresses to death.
• Early intervention for recurrence has been shown to be of benefit but current methods of localizing recurrence are either insensitive (CT), non-specific (MRI) or both (bone scan). Many prostate cancers express the prostate specific membrane antigen (PSMA) a transmembrane protein with NAALADase (N-acetylated-alpha-linked-acidic dipeptidase) and folate hydrolase enzymatic activity. PSMA is also expressed in angiogenesis but otherwise has limited expression in normal tissue.
• An initial test of 18F-DCFBC, a first-generation PET agent targeting PSMA, in patients with advanced local disease and biochemically recurrent prostate cancer demonstrated the potential of PET to detect sites of recurrence but it was hampered by excessive blood pool activity.
• (18)F-DCFPyL, a second generation PSMA PET agent, binds with high affinity to PSMA yet clears rapidly from the blood pool and thus, whole-body PET imaging with this agent, may provide a new tool in staging high risk cancers and detecting recurrent disease.

Primary Objective:

-To assess the ability of 18F-DCFPyL to accurately stage high-risk primary prostate cancer and detect sites of recurrent prostate cancer.

Eligibility:

• Age >=18 years old
• ECOG 0-2
• Histologically confirmed adenocarcinoma of the prostate
• Patients fit criteria for one of the following categories:

• Cohort 1: known localized high risk prostate cancer (PSA >10, Gleason 8-10 or clinical stage >T2c) with evidence of disease on standard imaging

or

--Cohort 2: nonspecific or no evidence of disease on standard imaging modality AND biochemical prostate cancer relapse with a PSA > 0.2 ng/ml

Design:

• This is a single site study evaluating 18F-DCFPyL high-risk primary prostate cancer and recurrent prostate cancer.
• All subjects will undergo 18F-DCFPyL injection and whole body PET/CT imaging, performed 2 hours (+/- 15 minutes) post 18F-DCFPyL injection.
• Up to 10 eligible patients in either cohort 1 or 2 will receive an additional (18)F-DCFPyL PET/CT scan within 1 month of the first study immediately after unilateral salivary gland cannulation and an infusion of unlabeled DCFPyL or PSMA-11 into the cannulated gland.
• Patients from cohort 2 who have a positive 18F-DCFPyL PET/CT scan at any time may also have a one-time 18F-FDG PET/CT within 30 days of the positive 18F-DCFPyL PET/CT.
• All patients will undergo a standard of care, clinical multiparametric MRI in the NCI Molecular Imaging Clinic within 4 months of the PET scan.
• The patients will be followed yearly for 4 years by chart review, phone-call, email or any other NIH approved platform for PSA relapse and radiologic evidence of metastatic disease. Additional (18)F-DCFPyL might be performed during the subject s follow up period if there has been a considerable change in patient status (progression or response) based on PSA value, symptomatology, bone scan or CT findings.

• INCLUSION CRITERIA:
• Age greater than or equal to 18 years old.
• Eastern Cooperative Oncology Group (ECOG) Performance score of 0 to 2.
• Ability of subject to understand and the willingness to sign a written informed consent document.
• Histologically confirmed adenocarcinoma of the prostate.
• Patients (including those receiving androgen deprivation therapy) fit criteria for one of the following categories:

• Cohort 1 known localized high risk prostate cancer (PSA >10, Gleason 8-10 or clinical stage >T2c) with evidence of disease on standard imaging, OR
• Cohort 2 nonspecific or no evidence of disease on standard imaging modality AND biochemical prostate cancer relapse with a PSA greater than or equal to 0.2 ng/mL. Patients must be willing to undergo mandatory research biopsy
• Participants must be co-enrolled on a MIB, UOB, GMB or ROB protocol.
• The effects of 18F-DCFPyL on the developing human fetus are unknown. For this reason, individuals must agree to use adequate contraception with their partner (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation and 2 months after 18F-DCFPyL scan. Should a partner become pregnant or suspect she is pregnant while her partner is participating in this study, she should inform the treating physician immediately.

Exclusion criteria

• Subjects for whom participating would significantly delay the scheduled standard of care therapy.
• Subjects with any coexisting medical or psychiatric condition that is likely to interfere with study procedures and/or results.
• Subjects with severe claustrophobia unresponsive to oral anxiolytics
• Other medical conditions deemed by the principal investigator (or associates) to make the subject unsafe/ineligible for protocol procedures.
• Subjects weighing greater than 350 lbs. (weight limit for scanner table), or unable to fit within the imaging gantry.
• Serum creatinine greater than 2 times the upper limit of normal.