Change in Salvage Radiotherapy Management Based on Guidance With FACBC (Fluciclovine) PET/CT in Postprostatectomy Recurrent Prostate Cancer

Abstract

Purpose We explored the influence of FACBC (fluciclovine) positron emission tomography-computed tomography (PET-CT) on the decision to offer radiotherapy and radiotherapy treatment field recommendations in post-prostatectomy patients with recurrent prostate cancer. Materials and Methods Following institutional review board approval and informed consent, 87 patients with detectable prostate specific antigen (PSA) were recruited into a prospective clinical trial. Following an initial provider-determined radiotherapy plan based on conventional imaging, 44/87 patients were randomized to additionally undergo fluciclovine PET-CT. Pre- and post-fluciclovine radiotherapy decisions were compared and changes noted. Statistical significance of these decision changes was determined. Results 2/44 patients in the experimental arm dropped out before fluciclovine scanning. 34/42 (81.0%) had positive results on fluciclovine. Overall radiotherapy decision was changed in 17/42 (40.5%). Mean PSA, original Gleason score (GS), and prostatectomy-PET interval did not differ significantly between patients with and without radiotherapy decision changes. 2/42 (4.8%) had the decision for radiotherapy withdrawn due to positive extra-pelvic findings. Radiotherapy field decision was changed in 15/42 (35.7%). 11/15 (73.3%) had fields changed from prostate bed only to both prostate bed and pelvis, while 4/15 (26.7%) had fields changed from both prostate bed and pelvis to prostate bed only. Changes in overall radiotherapy decision and field were statistically significant (P<0.0001). However, the change in the decision to offer radiotherapy or not was not statistically significant (P=0.15). Conclusion Fluciclovine PET-CT significantly changed radiotherapy management decisions in post-prostatectomy patients with recurrent prostate cancer. Further work in determining differences in PSA free survival is ongoing.

Incidental Accumulation of Fluciclovine in Neuroendocrine Tumour in a Patient with Oncological Duplicity

“…18F-fluciclovine (FCV) is a positron emission tomography (PET) radiopharmaceutical used for the detection of recurrent prostate cancer in adult men after primary curative treatment with the suspicion of recurrence based on elevated prostate-specific antigen (PSA) level [1]. The sensitivity of 18F-FCV PET for detecting recurrent disease increases with rising levels of PSA [2], the specificity for prostate bed in recurrent disease being 40-75%, as the residual prostate gland tissue is prone to uptake due to inflammation or prostatic hyper-trophy, the specificity for extraprostatic lesions was reported 97 and 100% [1,3,4]. FCV is accumulated by prostate cancer cells via specialised amino acids transporters, predominantly alanine-serine-cysteine transporter 2 (ASCT2) with contribution of l-amino acid transporter 1 (LAT-1) [1].…”

Update on 18F-Fluciclovine PET for Prostate Cancer Imaging

“…jnm.snmjournals.org Downloaded from planning mostly relies on conventional imaging, which may be unrevealing in the initial stages of prostate cancer recurrence. In a study involving 42 post prostatectomy patients randomized to undergo 18F-fluciclovine PET-CT after conventional radiotherapy planning, radiotherapy decisions were changed in 40.5% of patients after 18F-fluciclovine PET (24). However, the authors noted there was no statistically significant impact in this study on whether to actually offer radiotherapy, as only 2 of 42 patients had radiotherapy cancelled due to evidence of extrapelvic disease.…”

“…For personal use only. jnm.snmjournals.org Downloaded from detection rates in the post-prostatectomy biochemical failure setting of 72.0%, 83.3%, and 100% at PSA levels < 1, 1-2, and ≥2 ng/ml respectively (24). A mixed post-prostatectomy and nonprostatectomy cohort demonstrated a 18F-fluciclovine detection rate of 37.5% at PSA < 1, 77.8% at PSA 1-2, and 91.7% at PSA > 2, and 83.3% at PSA > 5 ng/ml (25).…”

Cost–consequence analysis of 18F-fluciclovine for the staging of recurrent prostate cancer

“…The model uses the sensitivity and specificity of each imaging modality to estimate the number of true positives, true negatives, false positives and false negatives to predict the health outcomes of the testing. Published clinical trial results were used to inform the test specification inputs for imaging of prostate cancer recurrent in the prostate bed and with extraprostatic involvement (Table 3) [8, [14][15][16][17]. Relevant studies were identified from Medline.…”