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Abstract

Purpose 

[18F]Sodium fluoride (NaF) positron emission tomography (PET)/computed tomography (CT) is a promising radiotracer for quantitative assessment of bone metastases. This study assesses changes in early NaF PET/CT response measures in metastatic prostate cancer for correlation to clinical outcomes. 

Patients and Methods 

Fifty-six patients with metastatic castration-resistant prostate cancer (mCRPC) with osseous metastases had NaF PET/CT scans performed at baseline and after three cycles of chemotherapy (n = 16) or androgen receptor pathway inhibitors (n = 40). A novel technology, Quantitative Total Bone Imaging, was used for analysis. Global imaging metrics, including maximum standardized uptake value (SUVmax) and total functional burden (SUVtotal), were extracted from composite lesion-level statistics for each patient and tracked throughout treatment. Progression-free survival (PFS) was calculated as a composite end point of progressive events using conventional imaging and/or physician discretion of clinical benefit; NaF imaging was not used for clinical evaluation. Cox proportional hazards regression analyses were conducted between imaging metrics and PFS. 

Results 

Functional burden (SUVtotal) assessed midtreatment was the strongest univariable PFS predictor (hazard ratio, 1.97; 95% CI, 1.44 to 2.71; P < .001). Classification of patients based on changes in functional burden showed stronger correlation to PFS than did the change in number of lesions. Various global imaging metrics outperformed baseline clinical markers in predicting outcome, including SUVtotal and SUVmean. No differences in imaging response or PFS correlates were found for different treatment cohorts. 

Conclusion

Quantitative total bone imaging enables comprehensive disease quantification on NaF PET/CT imaging, showing strong correlation to clinical outcomes. Total functional burden assessed after three cycles of hormonal therapy or chemotherapy was predictive of PFS for men with mCRPC. This supports ongoing development of NaF PET/CT-based imaging biomarkers in mCRPC to bone.

Author information

Harmon SA1, Perk T1, Lin C1, Eickhoff J1, Choyke PL1, Dahut WL1, Apolo AB1, Humm JL1, Larson SM1, Morris MJ1, Liu G1, Jeraj R1.

1 Stephanie A. Harmon, Timothy Perk, Christie Lin, Jens Eickhoff, Glenn Liu, and Robert Jeraj, University of Wisconsin-Madison; Glenn Liu and Robert Jeraj, Prostate Cancer Clinical Trials Consortium, Madison, WI; Peter L. Choyke, William L. Dahut, and Andrea B. Apolo, National Cancer Institute, Bethesda, MD; John L. Humm, Steven M. Larson, and Michael J. Morris, Memorial Sloan Kettering Cancer Center; and Steven M. Larson and Michael J. Morris, Prostate Cancer Clinical Trials Consortium, New York, NY.