Fluorine-18-Labeled Fluciclovine PET/CT in Clinical Practice: Factors Affecting the Rate of Detection of Recurrent Prostate Cancer

Savir-Baruch, Bital; Lovrec, Petra; Solanki, Abhishek A.; Adams, William; Yonover, Paul; Gupta, Gopal N.; Schuster, David M.

doi:10.2214/ajr.19.21153

Cited by 29 publications

(17 citation statements)

References 26 publications

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“…In contrast, relatively lower positivity rates on 18 F-fluciclovine PET/CT have been found by other studies (26,27), likely related to differences in mean PSA and PSA kinetics. Similar to other studies, we found that the detection rate of recurrent PCa on 18 F-fluciclovine PET/CT improves with increased PSA levels: 75.4% for PSA 1 ng/mL or lower and 90.9% for PSA higher than 1 ng/mL (19,25,28,29).…”

Section: Discussionsupporting

confidence: 90%

“…The whole-body positivity rate on 18 F-fluciclovine PET/CT was 79.7% in this study population, consistent with the reported positivity rates of 79.3% by Pernthaler (24) and 81% by Savir-Baruch (25). In contrast, relatively lower positivity rates on 18 F-fluciclovine PET/CT have been found by other studies (26,27), likely related to differences in mean PSA and PSA kinetics.…”

Section: Discussionsupporting

confidence: 89%

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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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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

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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“…The current literature provides inconsistent results on the role of PSA-dt as a predictor of PET/CT positivity. Some studies reported no statistically significant difference in DR between PSA-dt groups [9, 24], while others found the PSA-dt in patients with positive PET/CT was significantly shorter than PSA-dt in patients with negative findings [28]. In this study, the Mann-Whitney U test for PSA-dt yielded a BF 01 of 3.44.…”

Section: Discussionmentioning

confidence: 49%

“…Additionally, 18 F-fluciclovine PET/CT showed low performance at high PSA levels too (sensitivity 59% for PSA >3 ng/mL) [23], and several studies found no significant difference in PSA between patients with positive and negative 18 Ffluciclovine PET/CT scans [9]. One possible explanation could be the presence of other factors that have been re-ported to influence 18 F-fluciclovine PET/CT DR, such as the type of primary intervention, location of recurrence (prostatic vs. extraprostatic), and primary Gleason score [24][25][26][27][28][29]. Specifically, we did not perform a subgroup analysis for these factors due to the relatively small sample size; however, all of them were homogeneously distributed between the group samples.…”

Section: Discussionmentioning

confidence: 99%

PSA and PSA Kinetics as Predictors for 18F-Fluciclovine PET/CT Positivity in Biochemically Recurrent Prostate Cancer

et al. 2021

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Introduction: 18F-Fluciclovine PET/CT is one of the imaging techniques currently employed to restage prostate cancer (PCa). Due to the conflicting results reported in the literature, it is not yet known at what PSA threshold 18F-fluciclovine PET/CT could reliably demonstrate the presence of recurring disease. We explored the association between 18F-fluciclovine PET/CT positivity and prescan PSA, PSA doubling time, and PSA velocity in patients with biochemical recurrence (BCR) of PCa after curative-intent treatment. Methods: Data from 59 patients who underwent 18F-fluciclovine PET/CT for BCR after radical prostatectomy or radiotherapy were retrieved from a single institution database. Patients already undergone salvage treatments at the time of PET/CT, with newly diagnosed PCa or with initial diagnosis of metastatic PCa were excluded. A 2-sided independent samples Bayesian t test and Bayesian Mann-Whitney U test were used to assess the association between PET/CT and prescan PSA, PSA doubling time, and PSA velocity. Results: Evidence for no difference between PET/CT-positive and -negative patients for log-transformed PSA was found (BF01 3.61, % error: 0.01). Robustness check and sequential analysis showed stability across a wide range of prior distribution specifications. The hypothesis of no difference in terms of PSA-dt and for PSA-vel between groups was found to be more likely compared to the alternative hypothesis (BF01 of 3.44 and 3.48, respectively). Conclusion: PSA and PSA kinetics are unlikely to be associated with 18F-fluciclovine PET/CT positivity in patients with BCR, and none of these serum biomarkers might be used as single predictors of PET/CT detection. Larger studies might be needed to evaluate the role of different predictors.

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“…Positivity rates (PR)(25) were calculated for each imaging modality for various anatomic locations by dividing the number of patients with positive ndings in each anatomical area [intraprostatic, seminal vesicle (SV), penile bulb, bladder wall, pelvic lymph nodes (LN), extra-pelvic LN] by the total number of patients imaged with that modality. Lesions with available pathology results (ground truth) were used to calculate the positive predictive values (PPV) for both mpMRI and 18 F-DCFPyL PET/CT.…”

mentioning

confidence: 99%

Multiparametric MRI and 18F-DCFPyL PET/CT for detection of locally recurrent prostate cancer after low dose rate brachytherapy

Walker¹,

Fernández²,

Roy³

et al. 2020

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Background and purpose: Both multiparametric magnetic resonance imaging (mpMRI) and prostate specific membrane antigen (PSMA)-targeting positron emission tomography (PET) imaging have shown promise in early localization of prostate cancer (PCa) recurrence after primary external beam radiotherapy. Detecting recurrence after brachytherapy for PCa using MRI is significantly hampered by susceptibility artifacts secondary to brachy seeds. Here, we compare the efficacy of 18F-DCFPyL (2-(3-{1-carboxy-5-[(6-18F-fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid) PET/CT versus mpMRI for detecting sites of local recurrence after low dose rate (LDR) brachytherapy for prostate cancer.Materials and methods: A total of 155 patients with a history of recurrent PCa who underwent mpMRI at 3 Tesla and 18F-DCFPyL PET/CT were retrospectively reviewed. Patients who underwent LDR brachytherapy for PCa and had subsequent biochemical recurrence (BCR) followed by mpMRI and 18F-DCFPyL PET/CT were included in this study. mpMRI was performed on a 3T scanner with endorectal and surface coils and images were prospectively read by a single expert radiologist. The 18F-DCFPyL PET/CT scan was prospectively interpreted by one of two nuclear medicine physicians. Patients underwent targeted biopsy when deemed clinically necessary and specimens were interpreted by an expert GU pathologist. Positivity rates (PR) from mpMRI and 18F-DCFPyL PET/CT were compared, and pathology results were used to calculate the positive predictive value (PPV) of each imaging modality for detecting PCa recurrence.Results: 15 patients who underwent LDR brachytherapy and had subsequent biochemical failure were imaged with mpMRI and 18F-DCFPyL PET/CT. 18 non-lymph node lesions were identified on at least one imaging modality. The PR for detection of intraprostatic lesions was 60% (9/15) for both PET/CT and mpMRI, with 3 prostate lesions detected by only one modality. 18F-DCFPyL PET/CT identified pelvic and extra-pelvic lymph nodes in 8 (53%) patients, while mpMRI noted positive lymph node findings in only 2 (13%) patients. A total of 15 lesions corresponding to 9 patients were targeted for biopsy. The PPV of 18F-DCFPyL PET/CT and mpMRI for the detection of local recurrence were 84.6% and 71.4%, respectively. For the detection of intraprostatic lesions, 18F-DCFPyL PET/CT and mpMRI had a PPV of 87.5% and 71.4%, respectively. Conclusion: This case series analysis suggests that 18F-DCFPyL PET/CT may detect local and regional recurrent PCa after LDR brachytherapy at a higher rate than mpMRI and that it has the potential to detect suspicious pelvic lymph nodes at a much higher rate. Further studies are needed to validate these findings in larger cohorts.

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Fluorine-18-Labeled Fluciclovine PET/CT in Clinical Practice: Factors Affecting the Rate of Detection of Recurrent Prostate Cancer

Cited by 29 publications

References 26 publications

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

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

PSA and PSA Kinetics as Predictors for 18F-Fluciclovine PET/CT Positivity in Biochemically Recurrent Prostate Cancer

Multiparametric MRI and 18F-DCFPyL PET/CT for detection of locally recurrent prostate cancer after low dose rate brachytherapy

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Fluorine-18-Labeled Fluciclovine PET/CT in Clinical Practice: Factors Affecting the Rate of Detection of Recurrent Prostate Cancer

Cited by 29 publications

References 26 publications

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

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

PSA and PSA Kinetics as Predictors for 18F-Fluciclovine PET/CT Positivity in Biochemically Recurrent Prostate Cancer

Multiparametric MRI and 18F-DCFPyL PET/CT for detection of locally recurrent prostate cancer after low dose rate brachytherapy

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

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