Copper-Based PET Scan Shows Promise for Finding Prostate Cancer Recurrence Earlier

64CuCl2 PET/CT in Prostate Cancer Relapse
A 70-y-old man with Gleason 4 + 3 PCa treated with radical prostatectomy, with rising PSA level (1.34) and PSA doubling time of 5.3 mo.
(A) 64CuCl2 PET/CT images reveals focal uptake (dotted arrow) in residual right seminal vesicle.
(B) 18F-choline PET/CT is negative.
(C) T2-weighted axial image mpMRI shows hypointense area in right seminal vesicle remnants.
(D) Apparent-diffusion-coefficient map derived from diffusion-weighted imaging sequence shows focal area of signal restriction in correspondence to remnants of right seminal vesicle.

New Copper-Based PET Scan Shows Promise for Detecting Prostate Cancer Recurrence

Novel imaging technique may provide better detection of returning prostate cancer, especially when PSA levels are low

A new clinical trial (EudraCT Number: 2017-004332-11) investigating an innovative imaging technique could bring hope to men experiencing biochemical recurrence after prostate cancer treatment. The study, conducted by the Advanced Center Oncology Macerata in Italy, examines how copper-64 chloride (64CuCl2) PET/CT scans might improve detection of returning cancer, particularly when PSA levels are just beginning to rise.

Better Detection When It Matters Most

For many men who have undergone prostatectomy, rising PSA levels signal a potential cancer recurrence, but pinpointing exactly where the cancer has returned can be challenging with conventional imaging methods. This is where 64CuCl2 PET/CT shows remarkable promise.

"The study found this scanning method detected cancer recurrence in 82% of patients, compared to only 56% with conventional 18F-choline PET/CT," explains Dr. Arnoldo Piccardo, the lead researcher. "Most importantly, it performed significantly better when PSA levels were very low – below 1 ng/mL – when early detection can make the biggest difference in treatment outcomes."

How It Works

The technique takes advantage of a biological fact: cancer cells, including prostate cancer, tend to absorb more copper than normal tissue. By using radioactive copper-64 as a tracer, the PET scanner can identify areas where this uptake is occurring, potentially revealing cancer that other imaging methods might miss.

Unlike other tracers, 64CuCl2 is not excreted through the urinary tract, allowing for clearer images of the prostatic bed and pelvic area – precisely where prostate cancer often recurs after surgery.

What This Means for Patients

For men experiencing biochemical recurrence, this technology could offer several benefits:

  • Earlier detection of recurrence when PSA levels first begin to rise
  • Better localization of exactly where the cancer has returned
  • More precise targeting for salvage radiotherapy
  • Improved treatment planning and potentially better outcomes

"Finding where the cancer has returned is critical for determining the right treatment approach," says Dr. Piccardo. "The more precisely we can locate it, especially at low PSA levels, the better chance we have at successful salvage therapy."

Looking Forward

While the results are promising, experts note that more research is needed, particularly comparing this approach with newer PSMA-based imaging techniques that have emerged in recent years.

The radiation dose from the scan (5.7 mSv) is similar to other standard PET imaging methods, making it a reasonable option from a safety perspective. The main drawback is slightly longer scan times compared to other PET tracers.

The trial, which began in March 2018, continues to evaluate this technology's potential role in prostate cancer care. Patients interested in learning more about 64CuCl2 PET/CT should consult with their oncologists about current availability and whether it might be appropriate for their specific situation.

This article is based on published research and is intended for informational purposes only. It does not constitute medical advice. Always consult with your healthcare provider regarding your individual care.


64CuCl2 PET/CT Clinical Trial for Prostate Cancer Patients: A Comprehensive Overview

Let me provide you with an explanation of this clinical trial, now incorporating the recent commentary on this imaging technology.

Overview of the Clinical Trial

This trial (EudraCT Number: 2017-004332-11) is investigating the use of copper-64 chloride (64CuCl2) PET/CT imaging for patients with prostate cancer who have experienced biochemical relapse (rising PSA levels) after prostatectomy.

Key Points:

  1. Purpose: To determine if 64CuCl2 PET/CT imaging can better select patients who would benefit from salvage radiotherapy to the prostatic bed after prostate removal surgery.

  2. Who can participate: Adult and elderly men with prostate cancer who have had:

    • Previous prostatectomy
    • Signs of biochemical relapse (rising PSA levels indicating possible cancer return)

Why 64CuCl2 Is Being Studied

The research shows that copper uptake is generally increased in several tumors. Human copper transporter 1 is well represented in prostate cancer cells, making copper-based imaging potentially useful.

Potential Advantages:

  1. Better detection rate: The study found this scanning method detected cancer recurrence in 82% of patients, compared to 56% with 18F-choline PET/CT and 74% with multiparametric MRI.

  2. Superior for local recurrence: 64CuCl2 detected local recurrence in 64% of cases (compared to 30% with 18F-choline PET/CT and 50% with MRI).

  3. Works better with low PSA levels: Particularly effective at detecting cancer in patients with very low PSA levels (less than 1 ng/mL).

  4. Clearer pelvic images: 64CuCl2 is not excreted through the urinary tract, allowing for better visualization of the pelvic area where prostate cancer often returns.

  5. Reasonable radiation exposure: The radiation dose (5.7 mSv) is similar to other standard PET imaging techniques.

Limitations and Considerations

The perspective article by Ceci et al. highlights several important limitations:

  1. Lack of histopathologic confirmation: In most cases, there was no tissue sample to definitively confirm that positive findings were actual cancer recurrence.

  2. Longer scan times: 64CuCl2 requires acquisition times of about 6 minutes per bed position, resulting in total scan times 2-3 times longer than other PET tracers.

  3. Suboptimal decay characteristics: The 12.7-hour half-life and 18% β+ decay of 64Cu is not ideal for clinical PET/CT workflows.

  4. High liver radiation dose: 64CuCl2 shows approximately 10 times higher radiation dose to the liver than 68Ga-PSMA, which could limit its potential therapeutic applications.

  5. Comparator may be outdated: The study compared 64CuCl2 to 18F-choline PET/CT, but many academic centers have already transitioned to newer tracers like PSMA-directed PET/CT or 18F-fluciclovine PET/CT, which may perform better.

Future Outlook

The experts suggest that while initial data for prostate cancer detection is promising, more research is needed, including:

  1. Head-to-head comparisons with newer receptor-based radiotracers like 68Ga-PSMA-11
  2. Central image interpretation studies to validate findings
  3. Regulatory approval and reimbursement considerations

Whether 64CuCl2 becomes a standard option for prostate cancer diagnosis will depend on how it performs compared to these newer imaging methods.

Potential Benefits for Trial Participants

If you participate in this trial, you may benefit from:

  • Access to an innovative imaging technology with potentially higher detection rates
  • Better localization of recurrent cancer, especially in the prostatic bed
  • More precise targeting for salvage radiotherapy, potentially improving treatment outcomes
  • Early detection of recurrence, even with low PSA levels

If you're considering this trial, discussing with your oncologist is essential to understand how this imaging approach might benefit your specific situation.

Imaging Modalities Compared

There are several reasons to believe 64CuCl2 PET/CT yields better results than 18F-choline PET/CT:

  1. Higher overall detection rate: The Piccardo study showed 64CuCl2 PET/CT had an 82% detection rate of recurrent prostate cancer compared to only 56% for 18F-choline PET/CT. This difference was statistically significant (P < 0.001).

  2. Superior for local recurrence: 64CuCl2 was particularly better at detecting local recurrence in the prostatic bed (64% detection rate) compared to 18F-choline (30% detection rate).

  3. Better performance with low PSA levels: The study specifically noted that 64CuCl2 PET/CT had a higher detection rate than 18F-choline PET/CT in patients with PSA levels below 1 ng/mL. This is clinically important because early detection at lower PSA levels can lead to more successful salvage therapy.

  4. More favorable biodistribution: 64CuCl2 is not excreted through the urinary tract, unlike 18F-choline. This means there's no radiotracer in the bladder to interfere with imaging of the prostatic bed and pelvic area, where prostate cancer often recurs.

  5. Similar performance for distant metastases: Both techniques were comparable in detecting lymph node metastases (64CuCl2: 32%, 18F-choline: 30%) and bone metastases (both 8%).

The limitations noted by the experts primarily concerned 64CuCl2 compared to newer PSMA-based tracers, not to 18F-choline. When directly compared to 18F-choline, the evidence shows 64CuCl2 appears to be superior, particularly for detecting local recurrence and for patients with low PSA levels.

The main practical disadvantage of 64CuCl2 compared to 18F-choline is the longer imaging time required (6 minutes vs. 2-3 minutes per bed position).

 

Clinical Trials register - Search for eudract_number:2017-004332-11

The European Union Clinical Trials Register   allows you to search for protocol and results information on:
  • interventional clinical trials that were approved in the European Union (EU)/European Economic Area (EEA) under the Clinical Trials Directive 2001/20/EC
  • clinical trials conducted outside the EU/EEA that are linked to European paediatric-medicine development

EU/EEA interventional clinical trials approved under or transitioned to the Clinical Trial Regulation 536/2014 are publicly accessible through the
Clinical Trials Information System (CTIS).

The EU Clinical Trials Register currently displays   44306   clinical trials with a EudraCT protocol, of which   7355   are clinical trials conducted with subjects less than 18 years old.   The register also displays information on   18700   older paediatric trials (in scope of Article 45 of the Paediatric Regulation (EC) No 1901/2006).

Phase 1 trials conducted solely on adults and that are not part of an agreed paediatric investigation plan (PIP) are not publicly available (see Frequently Asked Questions ).   
 
EudraCT Number: 2017-004332-11 Sponsor Protocol Number: P.64Cu.002.02 Start Date*: 2018-03-28
Sponsor Name:A.C.O.M. -ADVANCED CENTER ONCOLOGY MACERATA -S.R.L.
Full Title: Use of 64CuCl2 PET/CT Imaging in the selection of patients with prostate cancer in biochemical relapse after prostatectomy, to be successfully treated with salvage radiotherapy on the prostatic bed
Medical condition: cancer on the prostatic bed
Disease: Version SOC Term Classification Code Term Level
20.0 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) 10060862 Prostate cancer PT
Population Age: Adults, Elderly Gender: Male
Trial protocol: IT (Trial now transitioned)
Trial results: (No results available)


64CuCl2 PET/CT in Prostate Cancer Relapse - PubMed

Arnoldo Piccardo  1 ,
pubmed.ncbi.nlm.nih.gov

Clinical Trial

. 2018 Mar;59(3):444-451.

doi: 10.2967/jnumed.117.195628. Epub 2017 Sep 8.

Affiliations

Free article

Clinical Trial

64CuCl2 PET/CT in Prostate Cancer Relapse

Arnoldo Piccardo et al. J Nucl Med. 2018 Mar.

Free article

Abstract

Our objective was to evaluate the biodistribution, kinetics, and radiation dosimetry of 64CuCl2 in humans and to assess the ability of 64CuCl2 PET/CT to detect prostate cancer (PCa) recurrence in patients with biochemical relapse.  

Methods: We prospectively evaluated 50 PCa patients with biochemical relapse after surgery or external-beam radiation therapy. All patients underwent 64CuCl2 PET/CT, 18F-choline PET/CT, and multiparametric MRI within 15 d of each other. Experienced readers interpreted the images, and the detection rate (DR) of each imaging modality was calculated. Histopathology, when available; clinical or laboratory response; and multidisciplinary follow-up were used to confirm the site of disease. In parallel, biodistribution, kinetics of the lesions, and radiation dosimetry of 64CuCl2 were evaluated.  

Results: From a dosimetric point of view, an administered dose of 200 MBq for 64CuCl2 translated into a 5.7-mSv effective dose. Unlike 18F-choline, 64CuCl2 was not excreted or accumulated in the urinary tract, thus allowing thorough pelvic exploration. The maximum 64CuCl2 uptake at the sites of PCa relapse was observed 1 h after tracer injection. In our cohort, 64CuCl2 PET/CT proved positive in 41 of 50 patients, with an overall DR of 82%. The DRs of 18F-choline PET/CT and multiparametric MRI were 56% and 74%, respectively. The difference between the DRs of 64CuCl2 PET/CT and 18F-choline PET/CT was statistically significant (P < 0.001). Interestingly, on considering prostate-specific antigen (PSA) value, 64CuCl2 PET/CT had a higher DR than 18F-choline PET/CT in patients with a PSA of less than 1 ng/mL. 

Conclusion: The biodistribution of 64CuCl2 is more suitable than that of 18F-choline for exploring the pelvis and prostatic bed. The 64CuCl2 effective dose is like those of other established PET tracers. In patients with biochemical relapse and a low PSA level, 64CuCl2 PET/CT shows a significantly higher DR than 18F-choline PET/CT.

Keywords: 64CuCl2; PET/CT; dosimetry; elderly; prostate cancer.

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