Diagnostic Performance of PET/CT Using 18F-FACBC in Prostate Cancer: A Meta-Analysis

Abstract

Background: Diagnostic performance of PET/CT using 18F-fluciclovine (18F-FACBC) in patients with prostate cancer (PCa) has been evaluated in only a few studies. There is no consensus on the diagnostic value of 18F-FACBC PET/CT in PCa recurrence or metastasis (except for bone metastasis), the primary diagnosis of the lesion. Hence, a meta-analysis was conducted to evaluate the performance of 18F-FACBC PET/CT. Methods: The literature published from June 2015 to June 2019 on using 18F-FACBC PET/CT for the diagnosis of PCa was retrieved from PubMed and EMBASE. Pooled sensitivity (Sen), specificity (Spe), positive and negative likelihood ratios (LR+ and LR-), area under the curve (AUC), and diagnostic odds ratio (DOR) of 18F-FACBC PET/CT in patients with PCa were calculated. An SROC map was made, and a meta-regression analysis was carried out. A Fagan plot and likelihood ratio dot plot were drawn. Sensitivity and funnel plot analysis were made. Meta-disc, Review Manager 5.3, and STATA 13 were used for the meta-analysis. Results: A total of nine articles met the strict criteria for diagnostic meta-analysis, which included 363 patients and 345 lesions. Pooled Sen, Spe, LR+, LR-, DOR were 0.88, 0.73, 3.3, 0.17, and 20, respectively. Lesions detected on the PET/CT image included primary lesions and metastases. For the lesion, the doctors considered the abnormal part as a lesion on the PET/CT image by their own experience and expertise, including primary lesions and metastases. For the patient, patients who participated in the trial can be diagnosed as PCa through 18F-FACBC. Conclusion: This study comprehensively evaluated the diagnostic value of 18F-FACBC PET/CT on PCa. Our analysis suggests that 18F-FACBC PET/CT is a valuable agent in diagnosing PCa. More studies are needed for further validation.

Diagnostic Performance of PET Imaging Using Different Radiopharmaceuticals in Prostate Cancer According to Published Meta-Analyses

“…In some meta-analyses, diagnostic accuracy of 18 F-FACBC PET/CT was reported as moderate: higher in the staging than restaging setting [ 8 , 32 , 33 , 34 , 35 , 36 ]. In the first meta-analysis by Ren et al [ 36 ], 18 F-FACBC PET/CT demonstrated a pooled sensitivity and pooled specificity of 87% and 66%, respectively, in detecting BR-PCa.…”

“…Another two recent meta-analyses [33,34] confirmed the good sensitivity (86-88%) and moderate specificity (73-76%) of 18 F-FACBC PET/CT in staging and restaging PCa.…”

“…11 C-acetate PET/CT showed intermediate or low-accuracy values both in PCa staging and restaging setting [ 11 , 14 , 38 ]. 18 F-FACBC PET/CT showed good accuracy values, with better performance in the staging than in restaging setting [ 8 , 32 , 33 , 34 , 35 , 36 ]. High accuracy values of 18 F-NaF PET/CT emerged in the detection of bone metastases of patients with PCa [ 4 , 37 ].…”

“…Different radiotracers for PET imaging have been proposed in recent years, such as radiolabeled choline (Cho) [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], prostate-specific membrane antigen (PSMA)-targeted agents [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], 18 F-fluciclovine (FACBC) [ 8 , 32 , 33 , 34 , 35 , 36 ], 18 F-fluoride (NaF) [ 4 , 37 ], 11 C-acetate [ 11 , 14 , 38 ], and 18 F-fluorodeoxyglucose ( 18 F-FDG) [ 11 , 14 ]. Moreover, different radioisotopes have been proposed to label some of these radiopharmaceuticals, such as to label Cho (e.g., 18 F, 11 C) and PSMA-targeted agents (e.g., 68 Ga, 18 F, 64 Cu).…”

Role of metabolic imaging in diagnosis of primary, metastatic, and recurrent prostate cancer

“…18F-fluciclovine is more practical to handle than 11C-choline because of a physical half-life of 110 min for the former compared to 20 min for the latter [55,56]. Moreover, 18Ffluciclovine exhibits little renal excretion or bladder uptake compared to 11C-choline, allowing for better visualization of the prostate and greater accuracy of detection of involved sites in distant lymph nodes [57]. This increase in accuracy was demonstrated by Nanni et al [58] who showed that 18F -fluciclovine was statistically significantly superior to 11Ccholine in detecting both local and distant sites of disease recurrence.…”