A Prospective Head-to-Head Comparison of 18F-Fluciclovine With 68Ga-PSMA-11 in Biochemical Recurrence of Prostate Cancer in PET/CT: A Special Aspect in Imaging Local Recurrence: Reply

Pernthaler, Birgit; Kvaternik, Herbert; Aigner, Reingard

doi:10.1097/rlu.0000000000002913

Cited by 12 publications

(15 citation statements)

References 7 publications

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“…The overall positivity rate of 18 F-fluciclovine PET was 59% in a published study (6). Similarly, higher positivity rates were seen for PSMA-based radiotracers in head-to-head direct comparisons of 68 Ga-PSMA-11 to 18 F-fluciclovine (23,24). Interestingly, we report 3 patients with prostate bed uptake on 18 F-fluciclovine PET who had multiple extrapelvic lesions but no prostate bed lesion identified on 18 F-DCFPyL PET.…”

Section: Discussionsupporting

confidence: 56%

Prospective Evaluation of ¹⁸F-DCFPyL PET/CT in Biochemically Recurrent Prostate Cancer in an Academic Center: A Focus on Disease Localization and Changes in Management

et al. 2019

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18 F-DCFPyL (2-(3-{1-carboxy-5-[(6-18 F-fluoropyridine-3-carbonyl)amino]-pentyl}-ureido)-pentanedioic acid) is a promising PET radiopharmaceutical targeting prostate-specific membrane antigen (PSMA). We present our experience with this single-academic-center prospective study evaluating the positivity rate of 18 F-DCFPyL PET/CT in patients with biochemical recurrence (BCR) of prostate cancer (PC). Methods: We prospectively enrolled 72 men (52-91 y old; mean ± SD, 71.5 ± 7.2) with BCR after primary definitive treatment with prostatectomy (n 5 42) or radiotherapy (n 5 30). The presence of lesions compatible with PC was evaluated by 2 independent readers. Fifty-nine patients had scans concurrent with at least one other conventional scan: bone scanning (24), CT (21), MR (20), 18 F-fluciclovine PET/CT (18), or 18 F-NaF PET (14). Findings from 18 F-DCFPyL PET/CT were compared with those from other modalities. Impact on patient management based on 18 F-DCFPyL PET/CT was recorded from clinical chart review. Results: 18 F-DCFPyL PET/CT had an overall positivity rate of 85%, which increased with higher prostate-specific antigen (PSA) levels (ng/mL): 50% (PSA , 0.5), 69% (0.5 # PSA , 1), 100% (1 # PSA , 2), 91% (2 # PSA , 5), and 96% (PSA $ 5). 18 F-DCFPyL PET detected more lesions than conventional imaging. For anatomic imaging, 20 of 41 (49%) CT or MRI scans had findings congruent with 18 F-DCFPyL, whereas 18 F-DCFPyL PET was positive in 17 of 41 (41%) cases with negative CT or MRI findings. For bone imaging, 26 of 38 (68%) bone or 18 F-NaF PET scans were congruent with 18 F-DCFPyL PET, whereas 18 F-DCFPyL PET localized bone lesions in 8 of 38 (21%) patients with negative results on bone or 18 F-NaF PET scans. In 8 of 18 (44%) patients, 18 F-fluciclovine PET had located the same lesions as did 18 F-DCFPyL PET, whereas 5 of 18 (28%) patients with negative 18 F-fluciclovine findings had positive 18 F-DCFPyL PET findings and 1 of 18 (6%) patients with negative 18 F-DCFPyL findings had uptake in the prostate bed on 18 F-fluciclovine PET. In the remaining 4 of 18 (22%) patients, 18 F-DCFPyL and 18 F-fluciclovine scans showed different lesions. Lastly, 43 of 72 (60%) patients had treatment changes after 18 F-DCFPyL PET and, most noticeably, 17 of these patients (24% total) had lesion localization only on 18 F-DCFPyL PET, despite negative results on conventional imaging. Conclusion: 18 F-DCFPyL PET/CT is a promising diagnostic tool in the work-up of biochemically recurrent PC, given the high positivity rate as compared with Food and Drug Administration-approved currently available imaging modalities and its impact on clinical management in 60% of patients.

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Section: Discussionsupporting

confidence: 56%

Prospective Evaluation of ¹⁸F-DCFPyL PET/CT in Biochemically Recurrent Prostate Cancer in an Academic Center: A Focus on Disease Localization and Changes in Management

et al. 2019

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“…12,15,16 Two recent studies have prospectively compared the performance of 18 F-fluciclovine and 68 Ga-PSMA with interesting findings. 29,30 Although Calais et al 29 reported 68 Ga-PSMA-11 to achieve higher overall detection (56%) than 18 F-fluciclovine (26%) in a single-center, low-PSA cohort (< 2 ng/ mL), Pernthaler et al 30 reported less variation between the detection rates achieved with 68 Ga-PSMA-11 (82.8 %) and 18 F-fluciclovine (79.3%). Pernthaler's cohort had a wider PSA range (median 4.1 ng/mL) than Calais'; however, when limiting to only those patients with a PSA 2 ng/mL, detection rates for 68 Ga-PSMA-11 and 18 F-fluciclovine were still less varied (53% vs 42%, respectively) than in the Calais study.…”

Section: Discussionmentioning

confidence: 99%

Effect of 18F-Fluciclovine Positron Emission Tomography on the Management of Patients With Recurrence of Prostate Cancer: Results From the FALCON Trial

Scarsbrook

Bottomley

Teoh

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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“…In the preliminary analysis of an ongoing prospective study of 68 Ga-PSMA-11 and 18 F-fluciclovine that included 50 patients with BRPC after primary prostatectomy, 68 Ga-PSMA-11 demonstrated consistently higher detection rates than 18 F-Fluciclovine in all anatomic regions: prostate bed (20% vs. 12%, respectively), pelvic nodes (37% vs. 14%), extra-pelvic nodes (8% vs. 2%), skeleton (8% vs. 2%), and visceral organs (6% vs. 2%) [ 19 ]. In a study comparing 68 Ga-PSMA-11 with 18 F-Fluciclovine, Pernthaler et al observed almost equivalent detection rates for distant metastases, but poorer performance of 68 Ga-PSMA-11 in detection of curable localized disease close to the bladder, possibly due to radiotracer accumulation [ 20 ].…”

Section: Uses and Impact Of Psma-targeted Imagingmentioning

confidence: 99%

PSMA Theranostics: Review of the Current Status of PSMA-Targeted Imaging and Radioligand Therapy

Jones

Griffiths

Barata

et al. 2020

Cancers

105

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Prostate-specific membrane antigen (PSMA) has been the subject of extensive investigation in the past two decades as a promising molecular target for prostate cancer (PCa). Its appealing molecular features have enabled the development of a novel diagnostic and therapeutic—thus “theranostic”—approach to PCa. There is now substantial evidence of the high sensitivity of PSMA-targeted imaging for PCa lesions and growing evidence of the therapeutic efficacy of PSMA radioligand therapy for metastatic castration-resistant prostate cancer. This article presents a broad overview of the current status of PSMA theranostics, including current evidence, potential clinical impact, and active areas of research.

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A Prospective Head-to-Head Comparison of 18F-Fluciclovine With 68Ga-PSMA-11 in Biochemical Recurrence of Prostate Cancer in PET/CT: A Special Aspect in Imaging Local Recurrence: Reply

Cited by 12 publications

References 7 publications

Prospective Evaluation of ¹⁸F-DCFPyL PET/CT in Biochemically Recurrent Prostate Cancer in an Academic Center: A Focus on Disease Localization and Changes in Management

Prospective Evaluation of ¹⁸F-DCFPyL PET/CT in Biochemically Recurrent Prostate Cancer in an Academic Center: A Focus on Disease Localization and Changes in Management

Effect of 18F-Fluciclovine Positron Emission Tomography on the Management of Patients With Recurrence of Prostate Cancer: Results From the FALCON Trial

PSMA Theranostics: Review of the Current Status of PSMA-Targeted Imaging and Radioligand Therapy

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A Prospective Head-to-Head Comparison of 18F-Fluciclovine With 68Ga-PSMA-11 in Biochemical Recurrence of Prostate Cancer in PET/CT: A Special Aspect in Imaging Local Recurrence: Reply

Cited by 12 publications

References 7 publications

Prospective Evaluation of 18F-DCFPyL PET/CT in Biochemically Recurrent Prostate Cancer in an Academic Center: A Focus on Disease Localization and Changes in Management

Prospective Evaluation of 18F-DCFPyL PET/CT in Biochemically Recurrent Prostate Cancer in an Academic Center: A Focus on Disease Localization and Changes in Management

Effect of 18F-Fluciclovine Positron Emission Tomography on the Management of Patients With Recurrence of Prostate Cancer: Results From the FALCON Trial

PSMA Theranostics: Review of the Current Status of PSMA-Targeted Imaging and Radioligand Therapy

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Prospective Evaluation of ¹⁸F-DCFPyL PET/CT in Biochemically Recurrent Prostate Cancer in an Academic Center: A Focus on Disease Localization and Changes in Management

Prospective Evaluation of ¹⁸F-DCFPyL PET/CT in Biochemically Recurrent Prostate Cancer in an Academic Center: A Focus on Disease Localization and Changes in Management