Localized Prostate Cancer Detection with<sup>18</sup>F FACBC PET/CT: Comparison with MR Imaging and Histopathologic Analysis

Türkbey, Barış; Mena, Esther; Shih, Joanna H.; Pinto, Peter A.; Merino, María J.; Lindenberg, Maria Liza; Bernardo, Marcelino; McKinney, Yolanda; Adler, S. S.; Owenius, Rikard; Choyke, Peter L.; Kurdziel, Karen

doi:10.1148/radiol.13130240

Cited by 138 publications

(103 citation statements)

References 21 publications

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“…In these patients, the mean SUV max of the tumor was significantly higher than in the normal prostate, but there was again overlap between the 18F-fluciclovine mean SUV max in prostate cancer and benign prostate hyperplasia (BPH), 4.5 ± 0.5 vs 4.3 ± 0.6 respectively. Interestingly, combining the information of 18F-fluciclovine PET with MRI in this study increased the PPV from 50% for 18F-fluciclovine PET and 76% for MRI, to 82% for the combined data (18). Similar findings were reported in a recent study of 26 men with primary prostate cancer who underwent 18F-fluciclovine PET-CT followed by PET-MRI (19) which found a high sensitivity and low specificity in primary tumor identification, but 18F-fluciclovine PET did not outperform MRI alone in prostate lesion detection.…”

Section: F-fluciclovine Pet Diagnostic Performance Primary Diseasementioning

confidence: 64%

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Update on ¹⁸F-Fluciclovine PET for Prostate Cancer Imaging

2018

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Positron emission tomography (PET) is a functional imaging method that can exploit various aspects of tumor biology to enable greater detection of prostate cancer than can be provided by morphologic imaging alone. Anti-1-amino-3-[ 18 F]-flurocyclobutane-1-carboxylic acid (18F-fluciclovine) is a non-naturally occurring amino acid PET radiotracer that is recently United States Food and Drug Administration approved for detection of suspected recurrent prostate cancer. The tumor imaging features of this radiotracer mirror the upregulation of transmembrane amino acid transport that occurs in prostate cancer due to increased amino acid metabolism for energy and protein synthesis. This continuing medical education article provides an overview on 18F-fluciclovine PET diagnostic capabilities for primary and metastatic disease, including reviews of published comparisons to conventional imaging and other molecular imaging agents. Additionally, imaging procedure and interpretation is detailed including physiologic and pathologic uptake patterns and pitfalls.

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Section: F-fluciclovine Pet Diagnostic Performance Primary Diseasementioning

confidence: 64%

“…Bone marrow may have heterogeneous activity, more so than is typically seen with 18 Schmorl's node with irregular borders has been described. Benign and malignant bone lesions (e.g.…”

Section: Image Interpretationmentioning

confidence: 99%

Update on ¹⁸F-Fluciclovine PET for Prostate Cancer Imaging

2018

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“…Anti-1-amino-3-18 Ffluorocyclobutane-1-carboxylic acid, a new synthetic amino acid, may be superior to 11 C-choline (47). However, a limitation of these PET tracers is the lack of specificity for distinguishing PC from benign prostate hypertrophy, which frequently coexists with PC (48). Therefore, different classes of PET radiopharmaceuticals, such as GRPR-targeted agents, may provide information useful in the management of PC.…”

Section: Clinical Usementioning

confidence: 99%

Bombesin-Targeted PET of Prostate Cancer

et al. 2016

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“…In a study of 10 patients with primary prostate carcinoma, although the SUV max was significantly higher in malignant sextants than in nonmalignant sextants and the Gleason score generally correlated with the SUV max , overlap of the SUV max in the benign and malignant sextants limited the utility of 18 F-fluciclovine PET for radiotherapy planning (46). In a prospective study of 21 patients with primary prostate cancer and with whole-mount step-section analysis as a reference standard, Turkbey et al reported that although the activity of 18 F-fluciclovine was significantly higher in prostate cancer than in normal prostate, 18 F-fluciclovine did not discriminate malignancy from benign prostatic hyperplasia (47). Interestingly, although a sector-based analysis of 18 F-fluciclovine demonstrated a sensitivity of 67% and a specificity of 66%-values inferior to the 73% sensitivity and 79% specificity of T2-weighted MRI-the highest positive predictive value (PPV), 82%, was achieved with a combination of 18 F-fluciclovine and MRI for tumor localization.…”

Section: Primary Prostate Cancer Diagnosis and Initial Stagingmentioning

confidence: 99%

Evaluation of Prostate Cancer with Radiolabeled Amino Acid Analogs

2016

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Conventional imaging of prostate cancer has limitations related to the frequently indolent biology of the disease. PET is a functional imaging method that can exploit various aspects of tumor biology to enable greater detection of prostate cancer than can be provided by morphologic imaging alone. Radiotracers that are in use or under investigation for targeting salient features of prostate cancer include those directed to glucose, choline, acetate, prostate-specific membrane antigen, bombesin, and amino acids. The tumor imaging features of this last class of radiotracers mirror the upregulation of transmembrane amino acid transport that is necessary in carcinomas because of increased amino acid use for energy requirements and protein synthesis. Natural and synthetic amino acids radiolabeled for PET imaging have been investigated in prostate cancer patients. Early work with naturally occurring amino acid-derived radiotracers, such as L-11 C-methionine and L-1-11 C-5-hydroxytryptophan, demonstrated promising results, including greater sensitivity than 18 F-FDG for intraprostatic and extraprostatic cancer detection. However, limitations with naturally occurring amino acid-derived compounds, including metabolism of the radiotracer itself, led to the development of synthetic amino acid radiotracers, which are not metabolized and therefore more accurately reflect transmembrane amino acid transport. Of the synthetic amino acid-derived PET radiotracers, anti-1-amino-3-18 F-fluorocyclobutane-1-carboxylic acid ( 18 F-FACBC or 18 F-fluciclovine) has undergone the most promising translation to human use, including the availability of simplified radiosynthesis. Several studies have indicated advantageous biodistribution in the abdomen and pelvis with little renal excretion and bladder activity-characteristics beneficial for prostate cancer imaging. Studies have demonstrated improved lesion detection and diagnostic performance of 18 F-fluciclovine in comparison with conventional imaging, especially for recurrent prostate cancer, although issues with nonspecific uptake limit the potential role of 18 F-fluciclovine in the diagnosis of primary prostate cancer. Although work is ongoing, recently published intrapatient comparisons of 18 F-fluciclovine with 11 C-choline reported higher overall diagnostic performance of the former, especially for the detection of disease relapse. This review is aimed at providing a detailed overview of amino acid-derived PET compounds that have been studied for use in prostate cancer imaging.

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Localized Prostate Cancer Detection with¹⁸F FACBC PET/CT: Comparison with MR Imaging and Histopathologic Analysis

Cited by 138 publications

References 21 publications

Update on ¹⁸F-Fluciclovine PET for Prostate Cancer Imaging

Update on ¹⁸F-Fluciclovine PET for Prostate Cancer Imaging

Bombesin-Targeted PET of Prostate Cancer

Evaluation of Prostate Cancer with Radiolabeled Amino Acid Analogs

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Localized Prostate Cancer Detection with18F FACBC PET/CT: Comparison with MR Imaging and Histopathologic Analysis

Cited by 138 publications

References 21 publications

Update on 18F-Fluciclovine PET for Prostate Cancer Imaging

Update on 18F-Fluciclovine PET for Prostate Cancer Imaging

Bombesin-Targeted PET of Prostate Cancer

Evaluation of Prostate Cancer with Radiolabeled Amino Acid Analogs

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Localized Prostate Cancer Detection with¹⁸F FACBC PET/CT: Comparison with MR Imaging and Histopathologic Analysis

Update on ¹⁸F-Fluciclovine PET for Prostate Cancer Imaging

Update on ¹⁸F-Fluciclovine PET for Prostate Cancer Imaging