¹⁸F-DCFPyL (PSMA) PET/CT for Assessment of Recurrent Prostate Cancer 

Please note that there is currently a waitlist for this study that can be up to 7 months long.

Principal Investigator: Dr. François Bénard
BC Cancer
600 W 10th Ave., Vancouver, BC, V5Z 4E6
PET Reception/Booking: 604.707.5951 (toll-free 1.800.663.3333, ext. 5951)
Fax Referrals to: 604.877.6245

Rationale & Background

Most patients with prostate cancer will be successfully treated with surgery or radiation therapy, a small proportion of patients will develop recurrence of disease at some time in their life. The prostate-specific antigen (PSA) is measured from a blood test and used to monitor the status of the cancer. When there is an unexpected and persistent rise in the PSA, this raises concern that the cancer may have returned. Imaging studies like magnetic resonance imaging, computerized tomography or bone scans are commonly performed for this purpose but may not always be able to detect cancer cells, especially when it is in the early stages.

This study is investigating the usefulness of an alternative test with a positron emission tomography/computerized tomography (PET/CT) scan using a radioactive tracer called ¹⁸F-DCFPyL. ¹⁸F-DCFPyL is an agent that binds to a special protein in the human body called prostate specific membrane antigen (PSMA). Studies have shown that PSMA is found in many prostate cancer cells, especially when the cancer comes back after treatment.

¹⁸F-DCFPyL will be made at the BC Cancer - Vancouver. It is considered investigational but has been used safely in preliminary human research studies without serious undesirable effects.

Objectives

The purpose of this study is to determine how accurate a ¹⁸F-DCFPyL PET/CT scan is in detecting prostate cancer recurrence.

Study Design

This is a prospective single cohort study to evaluate the diagnostic utility of ¹⁸F-DCFPyL PET/CT in detecting sites of recurrent prostate cancer, in patients who have negative or equivocal findings on conventional imaging. 

Up to 1574 adult patients will be invited to take part in this study. The study involves one PET/CT exam using ¹⁸F-DCFPyL. All patient referrals that meet the indications for performing this test should be faxed to the Functional Imaging Department at BC Cancer – Vancouver Centre.

Participant Inclusion Criteria

• Known PC with a BR after initial curative therapy with radical prostatectomy, with a documented history of failure of PSA to fall to undetectable levels (PSA persistence) or undetectable PSA after radical prostatectomy with a subsequent detectable PSA that increased on 2 or more determinations (PSA recurrence). The patient may have received treatment following documentation of PSA persistence or PSA recurrence. The most recent PSA measurement must be greater than 0.4 ng/mL.
  

• Participants with findings on other examinations (such as plain x-ray, CT, MRI or bone scintigraphy and others) that are suspicious for metastatic disease but not conclusively diagnostic of metastatic disease.
  

• Known PC with BR after initial curative therapy with radiation therapy (including brachytherapy), with a PSA level >2 ng/mL above the nadir after radiation therapy.
  

• Castration resistant PC with a minimum PSA of 2.0 ng/mL with 2 consecutive rises above the nadir and castrate levels of testosterone (<1.7 nmol/L). Treatment does not need to be discontinued before the ¹⁸F-DCFPyL scan.
  

• ECOG performance status of 2 or less.
  

Below are the patient referral form and the main study consent form for adult patients.  Patients should not sign the consent form prior to arrival for their PET/CT scan. The consent forms are available for review purposes only.

• ¹⁸F-DCFPyL Referral Form
  
• ¹⁸F-DCFPyL Initial Contact Letter
  
• ¹⁸F-DCFPyL Consent Form
  

⁶⁸Ga-DOTATOC PET/CT in Neuroendocrine Tumours

Principal Investigator: Dr. François Bénard
BC Cancer
600 W 10th Ave., Vancouver, BC, V5Z 4E6
PET Reception/Booking: 604.707.5951 (toll-free 1.800.663.3333, ext. 5951)
Fax Referrals to: 604.877.6245

Rationale & Background

Neuroendocrine Tumours (NETs) arise from neural and endocrine cells which derive from the primitive cells of the neural crest and represent a heterogeneous group of tumours with distinct biology and clinical behaviour. Although most tumours are generally indolent, they can be aggressive and resistant to therapy. A unique feature of NETs is the over-expression of somatostatin receptor (SSTR). NETs are assessed with morphological imaging such as ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). NETs can also be imaged using radiolabelled SSTR analogs (like ¹¹¹In-pentreotide). ⁶⁸Ga-DOTA peptides were shown to have significantly higher SSTR binding affinity compared to ¹¹¹In-pentetreotide.

Objectives

To demonstrate the safety and sensitivity of ⁶⁸Gallium-DOTATOC (⁶⁸Ga-DOTATOC) Positron emission tomography/computed tomography (PET/CT) in diagnosis, staging and detection of SSTR positive tumours, particularly NETs.

Study Design

Up to 400 adult patients will be invited to take part in this study. The study involves two PET/CT exams, one using ⁶⁸Ga-DOTATOC and the other using ¹⁸F-FDG. All patient referrals that meet the indications for performing this test should be faxed to the Functional Imaging Department at BC Cancer – Vancouver Centre.

The indication for performing this test is the need for non-invasive, functional imaging for either staging or re-staging of:

• Gastroenteropancreatic tumours (e.g. carcinoids, gastrinoma, insulinoma, glucagonoma, VIPoma, etc.), functioning and non-functioning
• Sympathoadrenal system tumours (phaeochromocytoma, paraganglioma, neuroblastoma, ganglioneuroma)
• Medullary thyroid carcinoma
• Pituitary adenoma
• Medulloblastoma
  
• Merkel cell carcinoma
• Small-cell lung cancer (mainly primary tumours)
• Meningioma
• Or any other NET / with potential for overexpression of SSTR

Below are the patient referral form and the main study consent form for adult patients.  Patients should not sign the consent form prior to arrival for their PET/CT scan. The consent forms are available for review purposes only.

• DOTATOC Referral Form
  
• DOTATOC Consent Form
  

¹⁸F-FDOPA PET/CT in Neuroendocrine Tumours

Rationale & Background

Neuroendocrine tumours (NETs) are a heterogenous group of neoplasms characterized by their endocrine metabolism and histologic features. They have no specific primary location, however about 90% arise from the gastroenteropancreatic tract. Treatment of NETs depends on the extent of disease and the rate of tumour progression. Accurate staging is critical to establish the prognosis of the disease, to guide potentially curative surgical approaches, and to assist in therapeutic decision making between surgery, embolization techniques or systemic therapy. ¹⁸F-FDOPA PET/CT has been investigated as a potentially sensitive and specific staging and localization technique for NETs.

Objectives

The purpose of this study is to provide access to ¹⁸F-FDOPA PET/CT imaging to patients with NETs and to collect additional information about the safety and effectiveness of ¹⁸F-FDOPA PET/CT in this patient population.

Study Design

Up to 300 adult and pediatric patients will be invited to take part in this study. All patient referrals that meet the indications for performing this test should be faxed to the Functional Imaging Department at BC Cancer – Vancouver Centre.

The indication for performing this test is the need for non-invasive, functional assessment of patients suspected of having or who have been previously diagnosed with:

1. Medullary Thyroid Carcinoma:
   • Staging
   • Localization of clinically or biochemically (elevated calcitonin) suspected recurrent disease
   
   
2. Carcinoid Tumours:
   • Staging
   • Localization of recurrent disease
   • Surgical planning
   
   
3. Pheochromocytoma and Paraganglioma:
   • Diagnosis
   • Staging
   • Localization of recurrent disease
   
   
4. Pancreatic Islet Cell Tumours, Including Insulinoma:
   • Diagnosis
   • Staging
   • Surgical planning
   
   
5. Neuroblastoma:
   • Staging
   • Localization of recurrent disease

Other specific clinical indications of suspected or biopsy proven neuroendocrine neoplasia may be approved by BC Cancer on an individual basis.

Below are the patient referral form, main study consent form for adult patients, and the assent form for children age 7-13.  Patients should not sign the consent form prior to arrival for their PET/CT scan. The consent forms are available for review purposes only.

• FDOPA Referral Form
  
• FDOPA Adult Consent Form
• FDOPA Assent Form