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@ARTICLE{Dietlein:836360,
      author       = {Dietlein, Felix and Kobe, Carsten and Neubauer, Stephan and
                      Stockter, Simone and Fischer, Thomas and Schomäcker, Klaus
                      and Heidenreich, Axel and Zlatopolskiy, Boris D. and
                      Neumaier, Bernd and Drzezga, Alexander and Dietlein, Markus
                      and Schmidt, M.},
      title        = {{PSA}-{S}tratified {P}erformance of $^{18}${F}- and
                      $^{68}${G}a-{PSMA} {PET} in {P}atients with {B}iochemical
                      {R}ecurrence of {P}rostate {C}ancer},
      journal      = {Journal of nuclear medicine},
      volume       = {58},
      number       = {6},
      issn         = {2159-662X},
      address      = {New York, NY},
      publisher    = {Soc.},
      reportid     = {FZJ-2017-05481},
      pages        = {947 - 952},
      year         = {2017},
      abstract     = {Several studies outlined the sensitivity of 68Ga-labeled
                      PET tracers against the prostate-specific membrane antigen
                      (PSMA) for localization of relapsed prostate cancer in
                      patients with renewed increase in the prostate-specific
                      antigen (PSA), commonly referred to as biochemical
                      recurrence. Labeling of PSMA tracers with 18F offers
                      numerous advantages, including improved image resolution,
                      longer half-life, and increased production yields. The aim
                      of this study was to assess the PSA-stratified performance
                      of the 18F-labeled PSMA tracer 18F-DCFPyL and the
                      68Ga-labeled reference 68Ga-PSMA-HBED-CC. Methods: We
                      examined 191 consecutive patients with biochemical
                      recurrence according to standard acquisition protocols using
                      18F-DCFPyL (n = 62, 269.8 MBq, PET scan at 120 min after
                      injection) or 68Ga-PSMA-HBED-CC (n = 129, 158.9 MBq, 60 min
                      after injection). We determined PSA-stratified sensitivity
                      rates for both tracers and corrected our calculations for
                      Gleason scores using iterative matched-pair analyses. As an
                      orthogonal validation, we directly compared tracer
                      distribution patterns in a separate cohort of 25 patients,
                      sequentially examined with both tracers. Results: After
                      prostatectomy (n = 106), the sensitivity of both tracers was
                      significantly associated with absolute PSA levels (P = 4.3
                      × 10−3). Sensitivity increased abruptly, when PSA values
                      exceeded 0.5 μg/L (P = 2.4 × 10−5). For a PSA less than
                      3.5 μg/L, most relapses were diagnosed at a still limited
                      stage (P = 3.4 × 10−6). For a PSA of 0.5–3.5 μg/L,
                      PSA-stratified sensitivity was $88\%$ (15/17) for 18F-DCFPyL
                      and $66\%$ (23/35) for 68Ga-PSMA-HBED-CC. This significant
                      difference was preserved in the Gleason-matched-pair
                      analysis. Outside of this range, sensitivity was comparably
                      low (PSA < 0.5 μg/L) or high (PSA > 3.5 μg/L). After
                      radiotherapy (n = 85), tracer sensitivity was largely
                      PSA-independent. In the 25 patients examined with both
                      tracers, distribution patterns of 18F-DCFPyL and
                      68Ga-PSMA-HBED-CC were strongly comparable (P = 2.71 ×
                      10−8). However, in $36\%$ of the PSMA-positive patients we
                      detected additional lesions on the 18F-DCFPyL scan (P = 3.7
                      × 10−2). Conclusion: Our data suggest that 18F-DCFPyL is
                      noninferior to 68Ga-PSMA-HBED-CC, while offering the
                      advantages of 18F labeling. Our results indicate that
                      imaging with 18F-DCFPyL may even exhibit improved
                      sensitivity in localizing relapsed tumors after
                      prostatectomy for moderately increased PSA levels. Although
                      the standard acquisition protocols, used for 18F-DCFPyL and
                      68Ga-PSMA-HBED-CC in this study, stipulate different
                      activity doses and tracer uptake times after injection, our
                      findings provide a promising rationale for validation of
                      18F-DCFPyL in future prospective trials.},
      cin          = {INM-5},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-5-20090406},
      pnm          = {573 - Neuroimaging (POF3-573)},
      pid          = {G:(DE-HGF)POF3-573},
      typ          = {PUB:(DE-HGF)16},
      UT           = {WOS:000402572500021},
      pubmed       = {pmid:27908968},
      doi          = {10.2967/jnumed.116.185538},
      url          = {https://juser.fz-juelich.de/record/836360},
}