Detection Rate and Clinical Impact of PET/CT with 18F-FACBC in Patients with Biochemical Recurrence of Prostate Cancer: A Retrospective Bicentric Study

Abstract

Our aim was to assess the detection rate (DR) of positron emission computed tomography (PET/CT) with anti-1-amino-3-[18F]-flurocyclobutane-1-carboxylic acid (18F-FACBC) in patients with biochemical recurrence (BCR) from prostate cancer (PC). As a secondary endpoint, we evaluated 18F-FACBC PET/CT’s impact on patients management. Clinical records of 81 patients submitted to 18F-FACBC PET/CT due to PC BCR in two Italian Nuclear Medicine Units were retrospectively assessed. DR was gauged in the whole cohort and stratifying patients by discrete intervals of PSA levels. PET/CT’s impact on clinical management was scored as (1) major if it entailed an intermodality change (e.g., from systemic to loco-regional therapy); (2) minor if it led to an intramodality change (e.g., modified radiotherapy field). PET/CT’s DR resulted in 76.9% in the whole cohort, with a positive predictive value of 96.7%. Stratified by PSA quartile intervals, PET/CT’s DR was 66.7%, 71.4%, 78.9% and 90% for PSA 0.2–0.57 ng/mL, 0.58–0.99 ng/mL, 1–1.5 ng/mL and >1.5 ng/mL without significant difference among groups (p = 0.81). The most common sites of relapse were prostate bed and pelvic lymph nodes (59.3%). PET/CT impacted on clinical management in 33/81 cases (40.7%), leading to a major change in 30 subjects (90.9%). 18F-FACBC PET/CT localized recurrence in patients with BCR, with meaningful DR also at low PSA levels and significantly impacted on clinical management.

[18F]fluciclovine vs. [18F]fluorocholine Positron Emission Tomography/Computed Tomography: A Head-to-Head Comparison for Early Detection of Biochemical Recurrence in Prostate Cancer Patients

“…These data were also recently confirmed in the retrospective study by Filippi et al, recording a promising performance for low PSA values (DR of 66.7% for PSA <0.57 ng/mL and of 71.4% for PSA 0.57–0.99 ng/mL). In addition, the authors identified 1.1 ng/mL as the optimal cut-off value in predicting a positive PET/CT scan [ 25 ]. The minimal PSA threshold to improve the [ 18 F]fluciclovine PET/CT DR in BCR PCa patients was already investigated by Armstrong et al, who suggested a PSA cut-off of 2.10 ng/mL [ 26 ].…”

The Performance of FDA-Approved PET Imaging Agents in the Detection of Prostate Cancer

“…The diagnostic performance of [ 18 F]FACBC was widely assessed after the FDA’s approval. The reported overall detection rate for [ 18 F]FACBC ranged from 40% to 80%, depending on the size of patient cohorts, and like [ 11 C]choline, its detection rate positively correlated with patients’ PSA levels(see Table 2 [ 37 , 38 , 39 , 40 , 41 , 42 , 43 ]). In a study investigating BCR patients with very low PSA levels (≤0.3 ng/mL), the detection rates were 43.8% for patients with PSA level below 0.1 ng/mL, increasing up to 65.2% for patients with PSA between 0.2 and 0.3 ng/mL [ 44 ].…”

The Value of Multimodality PET/CT Imaging in Detecting Prostate Cancer Biochemical Recurrence

“…18 F-fluciclovine PET is feasible for patients with PSA <1.0ng/ml. Filippi et al ( 54 ) found that the detection rate in 81 Italian patients was 66.7% when the PSA level was 0.2-0.57 ng/ml, and Wang et al. ( 75 ) in 46 patients with PSA level of 0.3-1.0ng/ml found the positive rate was about 33%, but it was not found positive cases in very low PSA (less than 0.3ng/ml) BCR patients.…”