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

Study Overview
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Brief Summary
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Background: Prostate cancer is the second leading cause of cancer deaths in American men. When prostate cancer is confined to the prostate there is a high chance of cure. However, it is outside the prostate or comes back after treatment, additional therapy may be needed. Current methods of imaging prostate cancer are limited. Researchers want to see if a radiotracer called 18F-DCFPyL can identify prostate cancer in patients who have a high risk of cancer spreading outside the prostate or who have signs of recurrent cancer after treatment. Objectives: To see if the radiotracer 18F-DCFyL can help identify prostate cancer in the body before or after therapy. Eligibility: Men ages 18 and older who have prostate cancer that has been newly diagnosed, or has relapsed after radiation or surgery Design: Participants will be screened with medical history and physical exam. They will have blood taken. Participants will be divided into 2 groups. Group 1 will be men with cancer that has been newly diagnosed as high risk by their doctor who are scheduled to have prostate removal surgery or undergo biopsy before radiation therapy. Group 2 will be men who have presumed prostate cancer relapse after prostate removal surgery or radiation therapy. Both groups will have scans taken. Participants will lie still on a table in a machine that takes pictures of their body. 18F-DCFyL will be injected by intravenous (IV) line. Participants will be contacted for follow-up after scans. Participants in Group 1 may have surgery to remove their prostate gland or a biopsy to remove some prostate tissue. This procedure will be standard of care and is not a part of this study. They will also have an extra MRI scan of their prostate. For this, a tube, called an endorectal coil, will be placed in their rectum. Other tubes may be wrapped around the inside of their pelvis. A contrast agent will be given by IV. Participants in Group 2 may also undergo an MRI of the pelvis and may have a biopsy of abnormalities found on the 18F-DCFyL scan. Participants will have data about their prostate cancer collected for up to 1 year.

Detailed Description
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Background: Prostate cancer (PCa) is the second leading cause of cancer death in American men. 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 enrolling a total of 395 patients 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 there has been a considerable change in patient status (progression or response) based on PSA value, symptomatology, bone scan or CT findings.

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

Conditions
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Prostate Neoplasms, Prostatic Cancer, Prostate Cancer, Cancer Of Prostate, Metastatic Prostate Cancer

Intervention / Treatment
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* Drug: 18F-DCFPyL
* Drug: 18F-FDG
* Drug: PSMA-11


Participation Criteria
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Eligibility Criteria
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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, men 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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1/Localized High Risk<br>18F-DCFPyL PET/CT imaging, unlabeled PSMA-11 (optional) and possible prostatectomy | Drug: 18F-DCFPyL<br>* Subjects will receive IV dose of 18F-DCFPyL by bolus injection. The maximum amount of injected active drug will be less than 4.02 mcg. The target administered activity will be 8 mCi.<br>Drug: PSMA-11<br>* For up to 10 eligible patients from either cohort 1 or 2, an optional salivary gland blocking study may be performed in which a salivary gland is cannulated and injected with unlabeled DCFPyL or PSMA-11.<br>|
| Experimental: 2/biochemical recurrence (bcr)<br>18F-DCFPyL PET/CT imaging, unlabeled PSMA-11 (optional) | Drug: 18F-DCFPyL<br>* Subjects will receive IV dose of 18F-DCFPyL by bolus injection. The maximum amount of injected active drug will be less than 4.02 mcg. The target administered activity will be 8 mCi.<br>Drug: 18F-FDG<br>* Cohort 2 may receive a one-time 18F-FDG PET/CT after a positive 18F-DCPyL PET/CT. 18F FDG PET/CT imaging may be performed per clinical standard of care. FDG is administered at a dose of 10mCi intravenously. A whole-body PET/CT will be performed beginning post 18F FDG injection.<br>Drug: PSMA-11<br>* For up to 10 eligible patients from either cohort 1 or 2, an optional salivary gland blocking study may be performed in which a salivary gland is cannulated and injected with unlabeled DCFPyL or PSMA-11.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To assess the ability of 18F-DCFPyL to accurately stage high-risk primary prostate cancer and detect sites of recurrent prostate cancer | Correlation between 18F-DCFPyL scanning and accurately staging of high-risk primary prostate cancer and detection of sites of recurrent prostate cancer. | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluate the distribution of 18F-DCFPyL uptake in prostate cancer patients with biochemical relapse (site of recurrence unknown) as a function of PSA value | PSA value of the distribution of 18F-DCFPyL uptake in prostate cancer patients with biochemical relapse | 12 month | 
| Compare the distribution of 18F-DCFPyL uptake with multiparametric MRI and whole mount histopathology in patients undergoing prostatectomy | Correlation between the distribution of 18F-DCFPyL uptake and multiparametric MRI and whole mount histopathology in patients undergoing prostatectomy | 12 month | 
| Compare focal 18F-DCFPyL uptake with focal abnormalities identified on standard of care imaging | Correlation between focal 18F-DCFPyL uptake and focal abnormalities identified on standard of care imaging | 12 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Imaging, Endorectal MRI, PSMA