Published Online:

anti-1-amino-3-fluorine 18-fluorocyclobutane-1-carboxylic acid PET/CT is more sensitive than 111In–capromab pendetide SPECT/CT in the detection of recurrent prostate carcinoma in the prostatic bed and extraprostatic sites.


To compare the diagnostic performance of the synthetic amino acid analog radiotracer anti-1-amino-3-fluorine 18-fluorocyclobutane-1-carboxylic acid (anti-3-18F-FACBC) with that of indium 111 (111In)–capromab pendetide in the detection of recurrent prostate carcinoma.

Materials and Methods

This prospective study was approved by the institutional review board and complied with HIPAA guidelines. Written informed consent was obtained. Fifty patients (mean age, 68.3 years ± 8.1 [standard deviation]; age range, 50–90 years) were included in the study on the basis of the following criteria: (a) Recurrence of prostate carcinoma was suspected after definitive therapy for localized disease, (b) bone scans were negative, and (c)anti-3-18F-FACBC positron emission tomography (PET)/computed tomography (CT) and 111In–capromab pendetide single photon emission computed tomography (SPECT)/CT were performed within 6 weeks of each other. Studies were evaluated by two experienced interpreters for abnormal uptake suspicious for recurrent disease in the prostate bed and extraprostatic locations. The reference standard was a combination of tissue correlation, imaging, laboratory, and clinical data. Diagnostic performance measures were calculated and tests of the statistical significance of differences determined by using the McNemar χ2 test as well as approximate tests based on the difference between two proportions.


For disease detection in the prostate bed, anti-3-18F-FACBC had a sensitivity of 89% (32 of 36 patients; 95% confidence interval [CI]: 74%, 97%), specificity of 67% (eight of 12 patients; 95% CI: 35%, 90%), and accuracy of 83% (40 of 48 patients; 95% CI: 70%, 93%). 111In–capromab pendetide had a sensitivity of 69% (25 of 36 patients; 95% CI: 52%, 84%), specificity of 58% (seven of 12 patients; 95% CI: 28%, 85%), and accuracy of 67% (32 of 48 patients; 95% CI: 52%, 80%). In the detection of extraprostatic recurrence, anti-3-18F-FACBC had a sensitivity of 100% (10 of 10 patients; 95% CI: 69%, 100%), specificity of 100% (seven of seven patients; 95% CI: 59%, 100%), and accuracy of 100% (17 of 17 patients; 95% CI: 80%, 100%). 111In–capromab pendetide had a sensitivity of 10% (one of 10 patients; 95% CI: 0%, 45%), specificity of 100% (seven of seven patients; 95% CI: 59%, 100%), and accuracy of 47% (eight of 17 patients; 95% CI: 23%, 72%).


anti-3-18F-FACBC PET/CT was more sensitive than 111In–capromab pendetide SPECT/CT in the detection of recurrent prostate carcinoma and is highly accurate in the differentiation of prostatic from extraprostatic disease.

© RSNA, 2011

Supplemental material:


  • 1 Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010;60(5):277–300. Crossref, MedlineGoogle Scholar
  • 2 Mohler J, Bahnson RR, Boston B, et al.. NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Canc Netw 2010;8(2):162–200. Crossref, MedlineGoogle Scholar
  • 3 Ward JF, Blute ML, Slezak J, Bergstralh EJ, Zincke H. The long-term clinical impact of biochemical recurrence of prostate cancer 5 or more years after radical prostatectomy. J Urol 2003;170(5):1872–1876. Crossref, MedlineGoogle Scholar
  • 4 Jhaveri FM, Zippe CD, Klein EA, Kupelian PA. Biochemical failure does not predict overall survival after radical prostatectomy for localized prostate cancer: 10-year results. Urology 1999;54(5):884–890. Crossref, MedlineGoogle Scholar
  • 5 Partin AW, Pearson JD, Landis PK, et al.. Evaluation of serum prostate-specific antigen velocity after radical prostatectomy to distinguish local recurrence from distant metastases. Urology 1994;43(5):649–659. Crossref, MedlineGoogle Scholar
  • 6 Okotie OT, Aronson WJ, Wieder JA, et al.. Predictors of metastatic disease in men with biochemical failure following radical prostatectomy. J Urol 2004;171(6 Pt 1):2260–2264. Crossref, MedlineGoogle Scholar
  • 7 Schöder H, Larson SM. Positron emission tomography for prostate, bladder, and renal cancer. Semin Nucl Med 2004;34(4):274–292. Crossref, MedlineGoogle Scholar
  • 8 Fowler JE, Brooks J, Pandey P, Seaver LE. Variable histology of anastomotic biopsies with detectable prostate specific antigen after radical prostatectomy. J Urol 1995;153(3 Pt 2):1011–1014. Crossref, MedlineGoogle Scholar
  • 9 Brassell SA, Rosner IL, McLeod DG. Update on magnetic resonance imaging, ProstaScint, and novel imaging in prostate cancer. Curr Opin Urol 2005;15(3):163–166. Crossref, MedlineGoogle Scholar
  • 10 Sartor O, McLeod D. Indium-111-capromab pendetide scans: an important test relevant to clinical decision making. Urology 2001;57(3):399–401. Crossref, MedlineGoogle Scholar
  • 11 Kundra V, Silverman PM, Matin SF, Choi H. Imaging in oncology from the University of Texas M. D. Anderson Cancer Center: diagnosis, staging, and surveillance of prostate cancer. AJR Am J Roentgenol 2007;189(4):830–844. Crossref, MedlineGoogle Scholar
  • 12 Lange PH. ProstaScint scan for staging prostate cancer. Urology 2001;57(3):402–406. Crossref, MedlineGoogle Scholar
  • 13 Seltzer MA, Barbaric Z, Belldegrun A, et al.. Comparison of helical computerized tomography, positron emission tomography and monoclonal antibody scans for evaluation of lymph node metastases in patients with prostate specific antigen relapse after treatment for localized prostate cancer. J Urol 1999;162(4):1322–1328. Crossref, MedlineGoogle Scholar
  • 14 Kelloff GJ, Choyke P, Coffey DS. Prostate Cancer Imaging Working Group. Challenges in clinical prostate cancer: role of imaging. AJR Am J Roentgenol 2009;192(6):1455–1470. Crossref, MedlineGoogle Scholar
  • 15 Choo R. Salvage radiotherapy for patients with PSA relapse following radical prostatectomy: issues and challenges. Cancer Res Treat 2010;42(1):1–11. Crossref, MedlineGoogle Scholar
  • 16 Schuster DM, Votaw JR, Nieh PT, et al.. Initial experience with the radiotracer anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid with PET/CT in prostate carcinoma. J Nucl Med 2007;48(1):56–63. MedlineGoogle Scholar
  • 17 Martarello L, McConathy J, Camp VM, et al.. Synthesis of syn- and anti-1-amino-3-[18F]fluoromethyl-cyclobutane-1-carboxylic acid (FMACBC), potential PET ligands for tumor detection. J Med Chem 2002;45(11):2250–2259. Crossref, MedlineGoogle Scholar
  • 18 McConathy J, Martarello L, Simpson NE, et al.. Uptake profiles of six 18F-labeled amino acids for tumor imaging: comparison of in vitro and in vivo uptake of branched chain and cyclobutyl amino acids by 9L gliosarcoma tumor cells [abstr]. J Nucl Med 2002;43(5):41P. Google Scholar
  • 19 Nye JA, Schuster DM, Yu W, Camp VM, Goodman MM, Votaw JR. Biodistribution and radiation dosimetry of the synthetic nonmetabolized amino acid analogue anti-18F-FACBC in humans. J Nucl Med 2007;48(6):1017–1020. Crossref, MedlineGoogle Scholar
  • 20 McConathy J, Voll RJ, Yu W, Crowe RJ, Goodman MM. Improved synthesis of anti-[18F]FACBC: improved preparation of labeling precursor and automated radiosynthesis. Appl Radiat Isot 2003;58(6):657–666. Crossref, MedlineGoogle Scholar
  • 21 Sodee DB, Nelson AD, Faulhaber PF, Maclennan GT, Resnick MI, Bakale G. Update on fused capromab pendetide imaging of prostate cancer. Clin Prostate Cancer 2005;3(4):230–238. Crossref, MedlineGoogle Scholar
  • 22 Kahn D, Williams RD, Haseman MK, Reed NL, Miller SJ, Gerstbrein J. Radioimmunoscintigraphy with In-111-labeled capromab pendetide predicts prostate cancer response to salvage radiotherapy after failed radical prostatectomy. J Clin Oncol 1998;16(1):284–289. Crossref, MedlineGoogle Scholar
  • 23 Thomas CT, Bradshaw PT, Pollock BH, et al.. Indium-111-capromab pendetide radioimmunoscintigraphy and prognosis for durable biochemical response to salvage radiation therapy in men after failed prostatectomy. J Clin Oncol 2003;21(9):1715–1721. Crossref, MedlineGoogle Scholar
  • 24 Schettino CJ, Kramer EL, Noz ME, Taneja S, Padmanabhan P, Lepor H. Impact of fusion of indium-111 capromab pendetide volume data sets with those from MRI or CT in patients with recurrent prostate cancer. AJR Am J Roentgenol 2004;183(2):519–524. Crossref, MedlineGoogle Scholar
  • 25 Venkitaraman R, Cook GJ, Dearnaley DP, et al.. Whole-body magnetic resonance imaging in the detection of skeletal metastases in patients with prostate cancer. J Med Imaging Radiat Oncol 2009;53(3):241–247. Crossref, MedlineGoogle Scholar
  • 26 Manyak MJ. Indium-111 capromab pendetide in the management of recurrent prostate cancer. Expert Rev Anticancer Ther 2008;8(2):175–181. Crossref, MedlineGoogle Scholar
  • 27 Hinkle GH, Burgers JK, Neal CE, et al.. Multicenter radioimmunoscintigraphic evaluation of patients with prostate carcinoma using indium-111 capromab pendetide. Cancer 1998;83(4):739–747. Crossref, MedlineGoogle Scholar
  • 28 Manyak MJ, Hinkle GH, Olsen JO, et al.. Immunoscintigraphy with indium-111-capromab pendetide: evaluation before definitive therapy in patients with prostate cancer. Urology 1999;54(6):1058–1063. Crossref, MedlineGoogle Scholar
  • 29 Sodee DB, Sodee AE, Bakale G. Synergistic value of single-photon emission computed tomography/computed tomography fusion to radioimmunoscintigraphic imaging of prostate cancer. Semin Nucl Med 2007;37(1):17–28. Crossref, MedlineGoogle Scholar
  • 30 Seo Y, Aparici CM, Cooperberg MR, Konety BR, Hawkins RA. In vivo tumor grading of prostate cancer using quantitative 111In-capromab pendetide SPECT/CT. J Nucl Med 2010;51(1):31–36. Crossref, MedlineGoogle Scholar
  • 31 Seo Y, Franc BL, Hawkins RA, Wong KH, Hasegawa BH. Progress in SPECT/CT imaging of prostate cancer. Technol Cancer Res Treat 2006;5(4):329–336. Crossref, MedlineGoogle Scholar
  • 32 Krämer S, Görich J, Gottfried HW, et al.. Sensitivity of computed tomography in detecting local recurrence of prostatic carcinoma following radical prostatectomy. Br J Radiol 1997;70(838):995–999. Crossref, MedlineGoogle Scholar
  • 33 Beresford MJ, Gillatt D, Benson RJ, Ajithkumar T. A systematic review of the role of imaging before salvage radiotherapy for post-prostatectomy biochemical recurrence. Clin Oncol (R Coll Radiol) 2010;22(1):46–55. Crossref, MedlineGoogle Scholar
  • 34 Rouvière O, Vitry T, Lyonnet D. Imaging of prostate cancer local recurrences: why and how? Eur Radiol 2010;20(5):1254–1266. Crossref, MedlineGoogle Scholar
  • 35 Haider MA, Chung P, Sweet J, et al.. Dynamic contrast-enhanced magnetic resonance imaging for localization of recurrent prostate cancer after external beam radiotherapy. Int J Radiat Oncol Biol Phys 2008;70(2):425–430. Crossref, MedlineGoogle Scholar
  • 36 De Visschere PJ, De Meerleer GO, Fütterer JJ, Villeirs GM. Role of MRI in follow-up after focal therapy for prostate carcinoma. AJR Am J Roentgenol 2010;194(6):1427–1433. Crossref, MedlineGoogle Scholar
  • 37 Briganti A. How to improve the ability to detect pelvic lymph node metastases of urologic malignancies. Eur Urol 2009;55(4):770–772. Crossref, MedlineGoogle Scholar
  • 38 Oyen RH, Van Poppel HP, Ameye FE, Van de Voorde WA, Baert AL, Baert LV. Lymph node staging of localized prostatic carcinoma with CT and CT-guided fine-needle aspiration biopsy: prospective study of 285 patients. Radiology 1994;190(2):315–322. LinkGoogle Scholar
  • 39 Takahashi N, Inoue T, Lee J, Yamaguchi T, Shizukuishi K. The roles of PET and PET/CT in the diagnosis and management of prostate cancer. Oncology 2007;72(3-4):226–233. Crossref, MedlineGoogle Scholar
  • 40 Heesakkers RA, Hövels AM, Jager GJ, et al.. MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: a prospective multicohort study. Lancet Oncol 2008;9(9):850–856. Crossref, MedlineGoogle Scholar
  • 41 Harisinghani MG, Barentsz J, Hahn PF, et al.. Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med 2003;348(25):2491–2499. Crossref, MedlineGoogle Scholar
  • 42 Thoeny HC, Triantafyllou M, Birkhaeuser FD, et al.. Combined ultrasmall superparamagnetic particles of iron oxide–enhanced and diffusion-weighted magnetic resonance imaging reliably detect pelvic lymph node metastases in normal-sized nodes of bladder and prostate cancer patients. Eur Urol 2009;55(4):761–769. Crossref, MedlineGoogle Scholar
  • 43 Schöder H, Herrmann K, Gönen M, et al.. 2-[18F]fluoro-2-deoxyglucose positron emission tomography for the detection of disease in patients with prostate-specific antigen relapse after radical prostatectomy. Clin Cancer Res 2005;11(13):4761–4769. Crossref, MedlineGoogle Scholar
  • 44 Nuñez R, Macapinlac HA, Yeung HW, et al.. Combined 18F-FDG and 11C-methionine PET scans in patients with newly progressive metastatic prostate cancer. J Nucl Med 2002;43(1):46–55. MedlineGoogle Scholar
  • 45 Beer AJ, Eiber M, Souvatzoglou M, Schwaiger M, Krause BJ. Radionuclide and hybrid imaging of recurrent prostate cancer. Lancet Oncol 2011;12(2):181–191. Crossref, MedlineGoogle Scholar
  • 46 Apolo AB, Pandit-Taskar N, Morris MJ. Novel tracers and their development for the imaging of metastatic prostate cancer. J Nucl Med 2008;49(12):2031–2041. Crossref, MedlineGoogle Scholar
  • 47 Hong H, Zhang Y, Sun J, Cai W. Positron emission tomography imaging of prostate cancer. Amino Acids 2010;39(1):11–27. Crossref, MedlineGoogle Scholar
  • 48 Bouchelouche K, Tagawa ST, Goldsmith SJ, Turkbey B, Capala J, Choyke P. PET/CT imaging and radioimmunotherapy of prostate cancer. Semin Nucl Med 2011;41(1):29–44. Crossref, MedlineGoogle Scholar
  • 49 Picchio M, Briganti A, Fanti S, et al.. The role of choline positron emission tomography/computed tomography in the management of patients with prostate-specific antigen progression after radical treatment of prostate cancer. Eur Urol. Published online September 15, 2010. Accessed March 11, 2011. Google Scholar
  • 50 Plathow C, Weber WA. Tumor cell metabolism imaging. J Nucl Med 2008;49(Suppl 2):43S–63S. Crossref, MedlineGoogle Scholar
  • 51 Tóth G, Lengyel Z, Balkay L, Salah MA, Trón L, Tóth C. Detection of prostate cancer with 11C-methionine positron emission tomography. J Urol 2005;173(1):66–69, discussion 69. Crossref, MedlineGoogle Scholar
  • 52 Crook J, Malone S, Perry G, Bahadur Y, Robertson S, Abdolell M. Postradiotherapy prostate biopsies: what do they really mean? Results for 498 patients. Int J Radiat Oncol Biol Phys 2000;48(2):355–367. Crossref, MedlineGoogle Scholar
  • 53 Cohen JH, Eastham J, Macchia RJ. Outcomes following negative prostate biopsy for patients with persistent disease after radiotherapy for prostate cancer. Int Braz J Urol 2010;36(1):44–48. Crossref, MedlineGoogle Scholar
  • 54 Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC. Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999;281(17):1591–1597. Crossref, MedlineGoogle Scholar
  • 55 Trock BJ, Han M, Freedland SJ, et al.. Prostate cancer–specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA 2008;299(23):2760–2769. Crossref, MedlineGoogle Scholar

Article History

Received October 8, 2010; revision requested November 17; revision received January 17, 2011; accepted January 26; final version accepted February 8.
Published online: June 2011
Published in print: June 2011