Inconsistent Detection of Sites of Metastatic Non-Clear Cell Renal Cell Carcinoma with PSMA-Targeted [18F]DCFPyL PET/CT
To investigate the utility of prostate-specific membrane antigen (PSMA)-targeted [18F]DCFPyL positron emission tomography (PET)/X-ray computed tomography (CT) imaging for the detection of sites of disease in patients with metastatic non-clear cell renal cell carcinoma (RCC).
Eight patients with metastatic non-clear cell RCC underwent imaging with PSMA-targeted [18F]DCFPyL PET/CT. Imaged RCC histologic subtypes included papillary RCC (n = 3), chromophobe RCC (n = 2), unclassified RCC (n = 2), and Xp11 translocation RCC (n = 1). Using comparison to conventional CT and/or magnetic resonance imaging as reference, two radiologists with expertise in nuclear medicine identified putative sites of disease on [18F]DCFPyL PET/CT and classified each lesion as having no radiotracer uptake, equivocal uptake, or definitive uptake.
In total, 73 metastatic sites and 3 primary tumors compatible with sites of non-clear cell RCC were identified on conventional imaging. Metastatic sites of disease included lymph nodes (n = 40), venous thrombi (n = 3), pulmonary nodules (n = 10), bone lesions (n = 15), brain lesions (n = 3), and retroperitoneal masses (n = 2). Only 10 of the 73 lesions (13.7 %) were classified as having definitive radiotracer uptake (median SUVmax = 3.25, range = 1.2–9.5), 14 lesions (19.2 %) had equivocal uptake (median SUVmax = 2.85, range = 0.5–6.5), and 49 lesions (67.1 %) had no definitive uptake above background (median SUVmax = 1.7, range = 0.2–3.0). The three primary renal tumors demonstrated lower radiotracer avidity relative to surrounding normal renal parenchyma.
A small proportion of sites of non-clear cell RCC showed uptake of the PSMA-targeted radiotracer [18F]DCFPyL. Unlike for clear cell RCC, the results of this study indicate that PSMA-based PET is not appropriate for imaging other RCC subtypes.
Key wordsProstate-specific membrane antigen Renal cell carcinoma RCC PSMA [18F]DCFPyL
Compliance with Ethical Standards
Conflict of Interest
MGP is a co-inventor on a United States Patent covering [18F]DCFPyL and as such is entitled to a portion of any licensing fees and royalties generated by this technology. MAG has served as a consultant to Progenics Pharmaceuticals, the licensee of [18F]DCFPyL. MAG and SPR have received research support from Progenics Pharmaceuticals.
- 1.Fitzmaurice C, Allen C, Barber RM et al (2017) Global, regional, and National Cancer Incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol 3:524–548CrossRefGoogle Scholar
- 8.Liu Y (2016) The place of FDG PET/CT in renal cell carcinoma: value and limitations. Front Oncol 6:201Google Scholar
- 12.Silver DA, Pellicer I, Fair WR, Heston WD, Cordon-Cardo C (1997) Prostate-specific membrane antigen expression in normal and malignant human tissues. Clin Cancer Res 3:81–85Google Scholar
- 14.Salas Fragomeni RA, Amir T, Sheikhbahaei S, Harvey SC, Javadi MS, Solnes LB, Kiess AP, Allaf ME, Pomper MG, Gorin MA, Rowe SP (2018) Imaging of non-prostate cancers using PSMA-targeted radiotracers: rationale, current state of the field, and a call to arms. J Nucl Med 59:871–877CrossRefGoogle Scholar
- 31.Sawicki LM, Buchbender C, Boos J, Giessing M, Ermert J, Antke C, Antoch G, Hautzel H (2017) Diagnostic potential of PET/CT using a 68Ga-labelled prostate-specific membrane antigen ligand in whole-body staging of renal cell carcinoma: initial experience. Eur J Nucl Med Mol Imaging 44:102–107CrossRefGoogle Scholar
- 33.Spatz S, Tolkach Y, Jung K, Stephan C, Busch J, Ralla B, Rabien A, Feldmann G, Brossart P, Bundschuh RA, Ahmadzadehfar H, Essler M, Toma M, Müller SC, Ellinger J, Hauser S, Kristiansen G (2018) Comprehensive evaluation of prostate specific membrane antigen expression in the vasculature of renal tumors: implications for imaging studies and prognostic role. J Urol 199:370–377CrossRefGoogle Scholar