Extraprostatic Uptake of <sup>18</sup>F-Fluciclovine: Differentiation of Nonprostatic Neoplasms From Metastatic Prostate Cancer

Robertson, Matthew; Sakellis, Christopher G.; Hyun, Hyewon; Jacene, Heather A.

doi:10.2214/ajr.19.21894

Cited by 15 publications

(46 citation statements)

References 70 publications

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“…The overexpression of ASCT2 and LAT1 is frequently found also in lung tumours, expecially in the non-small cell subtype, because the amino acid transport systems play a significant role in the upregulation of cell proliferation. A correlation between expression of LAT1 and tumour hypoxia was also found and probably represent a factor in resistance to platinum-based chemotherapy and a cause of an unfavourable prognosis in surgically non-resectable lung cancer [8,22,23]. Taking advantage of the absent renal excretion at the time of the scan, Schuster used Fluciclovine for the evaluation of renal masses; a focal uptake of the tracer in the renal site associated with morphological injury, must be considered suspect for malignant neoplasia.…”

Section: Discussionmentioning

confidence: 99%

“…In this case, Fluciclovine showed uncommon uptake in the lymph nodes at the mediastinal site; this data seems to be of uncertain interpretation, suggesting a possible metastatic involvement, although it is known from studies that Fluciclovine can be localized both in inflammatory processes and in large B-cell and T-cell lymphomas. Indeed, some authors have reported a LAT1 overexpression in T-cell lymphoblastic lymphoma and T-cell acute lymphoblastic leukemia [8].…”

Section: Take Home Messagementioning

confidence: 99%

“…In patients with prostate cancer, Fluciclovine ( 18 F) PET/ CT was found to have a high sensitivity (92.5%) and specificity (90.1%) for the focus of primary disease, but the sensitivity for detecting recurrent disease varies with PSA values [1]. However, Fluciclovine is not a specific tracer due to the upregulation of LAT1 and ASCT2 activities also present in other neoplasms, in recent post-radiotherapy or cryotherapy and in benign inflammatory processes (such as benign prostatic hyperplasia, chronic prostatitis, high-grade intraepithelial prostatic hyperplasia) [8,9]. Fluciclovine ( 18 F) is FDA approved for restaging PCa and is broadly used in EU as well.…”

Section: Introduction/aimmentioning

confidence: 99%

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Pictorial essay: incidental findings on 18F-Fluciclovine PET/CT scan

Romagnolo

Cottignoli

Palucci

et al. 2021

Clin Transl Imaging

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Introduction Fluorine-18 (18F) Fluciclovine (anti-1-amino-3-18F-fluorocyclobutane- 1-carboxylic acid [FACBC]) is a synthetic amino acid labeled with 18F, currently used as PET radiopharmaceutical to investigating prostate cancer, namely in the recurrent setting. Fluciclovine is transported to cell membranes by amino acid transporters, such as LAT1 and ASCT2. The upregulation of LAT-1 and ASCT2 activities is typical of prostate cancer but is also present in other pathological conditions such as non-prostatic neoplasms (e.g., lung cancer) and in benign inflammatory process (e.g., benign prostatic hyperplasia, chronic prostatitis, high-grade prostatic hyperplasia intraepithelial). Methods In this short essay we present a retrospective FACBC PET/CT analysis consisting of a selection of the five most relevant cases of patients referred in our centre to FACBC PET/CT for prostate cancer, with concomitant FACBC uptake in sites atyipical for prostate cancer. Results These five selected cases demonstrate FACBC uptake at the level of the pancreatic head, adrenal incidentalomas, pulmonary nodules, mediastinal lymph nodes and neoformative tissue of the rectal wall. Discussion Clinical cases selected in this pictorial essay have demonstrated that Fluciclovine is not an exclusive and specific radiotracer for prostate cancer and, therefore, can induce misdiagnosis. In fact, incidental benign and malignant uptake might occur and should be further evaluated with clinical correlation or other imaging.

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Section: Discussionmentioning

confidence: 99%

Section: Take Home Messagementioning

confidence: 99%

Section: Introduction/aimmentioning

confidence: 99%

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Pictorial essay: incidental findings on 18F-Fluciclovine PET/CT scan

Romagnolo

Cottignoli

Palucci

et al. 2021

Clin Transl Imaging

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“…Imaging with novel PET radiotracers has significantly influenced radiotherapy decision making and radiation planning in patients with recurrent PCa (3,9,15,16). 18 F-Fluciclovine (Axumin; Blue Earth Diagnostics, Ltd.) is a nonnatural amino acid PET radiotracer that is approved by the Food and Drug Administration for the detection of recurrent PCa in patients with rising PSA. Because of its high specificity for extraprostatic disease, 18 F-fluciclovine is able to identify both prostatic and extraprostatic recurrence across all PSA levels (17,18).…”

mentioning

confidence: 99%

“…18 F-Fluciclovine (Axumin; Blue Earth Diagnostics, Ltd.) is a nonnatural amino acid PET radiotracer that is approved by the Food and Drug Administration for the detection of recurrent PCa in patients with rising PSA. Because of its high specificity for extraprostatic disease, 18 F-fluciclovine is able to identify both prostatic and extraprostatic recurrence across all PSA levels (17,18). In a preliminary interim analysis of this study, at 87 of 165 accrual, a 40.5% change in salvage radiotherapy management was seen in postprostatectomy patients after guidance with 18 F-fluciclovine PET/CT (19).…”

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confidence: 99%

Salvage Radiotherapy Management Decisions in Postprostatectomy Patients with Recurrent Prostate Cancer Based on ¹⁸F-Fluciclovine PET/CT Guidance

et al. 2021

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Imaging with novel PET radiotracers has significantly influenced radiotherapy decision making and radiation planning in patients with recurrent prostate cancer (PCa). The purpose of this analysis was to report the final results for management decision changes based on 18 F-fluciclovine PET/CT findings and determine whether the decision change trend remained after completion of accrual. Methods: Patients with detectable prostate-specific antigen (PSA) after prostatectomy were randomized to undergo either conventional imaging (CI) only (arm A) or CI plus 18 F-fluciclovine PET/CT (arm B) before radiotherapy. In arm B, positivity rates on CI and 18 F-fluciclovine PET/CT for detection of recurrent PCa were determined. Final decisions on whether to offer radiotherapy and whether to include only the prostate bed or also the pelvis in the radiotherapy field were based on 18 F-fluciclovine PET/CT findings. Radiotherapy decisions before and after 18 F-fluciclovine PET/CT were compared. The statistical significance of decision changes was determined using the Clopper-Pearson (exact) binomial method. Prognostic factors were compared between patients with and without decision changes. Results: All 165 patients enrolled in the study had standard-of-care CI and were initially planned to receive radiotherapy. Sixty-three of 79 (79.7%) patients (median PSA, 0.33 ng/mL) who underwent 18 F-fluciclovine PET/CT (arm B) had positive findings. 18 F-Fluciclovine PET/CT had a significantly higher positivity rate than CI did for the whole body (79.7% vs. 13.9%; P , 0.001), prostate bed (69.6% vs. 5.1%; P , 0.001), and pelvic lymph nodes (38.0% vs. 10.1%; P , 0.001). Twenty-eight of 79 (35.4%) patients had the overall radiotherapy decision changed after 18 F-fluciclovine PET/CT; in 4 of 79 (5.1%), the decision to use radiotherapy was withdrawn because of extrapelvic disease detected on 18 F-fluciclovine PET/CT. In 24 of 75 (32.0%) patients with a final decision to undergo radiotherapy, the radiotherapy field was changed. Changes in overall radiotherapy decisions and radiotherapy fields were statistically significant (P , 0.001). Overall, the mean PSA at PET was significantly different between patients with and without radiotherapy decision changes (P 5 0.033). Conclusion: 18 F-Fluciclovine PET/CT significantly altered salvage radiotherapy decisions in patients with recurrent PCa after prostatectomy. Further analysis to determine the impact of 18 F-fluciclovine PET/CT guidance on clinical outcomes after radiotherapy is in progress.

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Initial Experience with the Radiotracer 18F-Fluciclovine PET/CT in Ovarian Cancer

et al. 2023

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Extraprostatic Uptake of ¹⁸F-Fluciclovine: Differentiation of Nonprostatic Neoplasms From Metastatic Prostate Cancer

Cited by 15 publications

References 70 publications

Pictorial essay: incidental findings on 18F-Fluciclovine PET/CT scan

Pictorial essay: incidental findings on 18F-Fluciclovine PET/CT scan

Salvage Radiotherapy Management Decisions in Postprostatectomy Patients with Recurrent Prostate Cancer Based on ¹⁸F-Fluciclovine PET/CT Guidance

Initial Experience with the Radiotracer 18F-Fluciclovine PET/CT in Ovarian Cancer

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Extraprostatic Uptake of 18F-Fluciclovine: Differentiation of Nonprostatic Neoplasms From Metastatic Prostate Cancer

Cited by 15 publications

References 70 publications

Pictorial essay: incidental findings on 18F-Fluciclovine PET/CT scan

Pictorial essay: incidental findings on 18F-Fluciclovine PET/CT scan

Salvage Radiotherapy Management Decisions in Postprostatectomy Patients with Recurrent Prostate Cancer Based on 18F-Fluciclovine PET/CT Guidance

Initial Experience with the Radiotracer 18F-Fluciclovine PET/CT in Ovarian Cancer

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Extraprostatic Uptake of ¹⁸F-Fluciclovine: Differentiation of Nonprostatic Neoplasms From Metastatic Prostate Cancer

Salvage Radiotherapy Management Decisions in Postprostatectomy Patients with Recurrent Prostate Cancer Based on ¹⁸F-Fluciclovine PET/CT Guidance