Update on ¹⁸F-Fluciclovine PET for Prostate Cancer Imaging

Abstract

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.

Incidental Accumulation of Fluciclovine in Neuroendocrine Tumour in a Patient with Oncological Duplicity

“…18F-fluciclovine (FCV) is a positron emission tomography (PET) radiopharmaceutical used for the detection of recurrent prostate cancer in adult men after primary curative treatment with the suspicion of recurrence based on elevated prostate-specific antigen (PSA) level [1]. The sensitivity of 18F-FCV PET for detecting recurrent disease increases with rising levels of PSA [2], the specificity for prostate bed in recurrent disease being 40-75%, as the residual prostate gland tissue is prone to uptake due to inflammation or prostatic hyper-trophy, the specificity for extraprostatic lesions was reported 97 and 100% [1,3,4]. FCV is accumulated by prostate cancer cells via specialised amino acids transporters, predominantly alanine-serine-cysteine transporter 2 (ASCT2) with contribution of l-amino acid transporter 1 (LAT-1) [1].…”

“…The sensitivity of 18F-FCV PET for detecting recurrent disease increases with rising levels of PSA [2], the specificity for prostate bed in recurrent disease being 40-75%, as the residual prostate gland tissue is prone to uptake due to inflammation or prostatic hyper-trophy, the specificity for extraprostatic lesions was reported 97 and 100% [1,3,4]. FCV is accumulated by prostate cancer cells via specialised amino acids transporters, predominantly alanine-serine-cysteine transporter 2 (ASCT2) with contribution of l-amino acid transporter 1 (LAT-1) [1].…”

Incidental detection of oropharyngeal cancer with fluciclovine PET

“…Owing to its relatively limited urinary excretion as compared to 18 [F]fluorodeoxyglucose ( 18 [F]FDG), fluciclovine was also evaluated for its ability to detect genitourinary malignancies, such as renal cell carcinoma and prostate adenocarcinoma . In the latter setting, fluciclovine uptake was increased in both primary and metastatic disease, specifically concerning pelvic lymph node involvement.…”

“…In the latter setting, fluciclovine uptake was increased in both primary and metastatic disease, specifically concerning pelvic lymph node involvement. Studies of fluciclovine in recurrent prostate adenocarcinoma emphasize the tracer's high sensitivity for tumor delineation, although specificity remains low in the prostate …”

New Radiopharmaceuticals and Preclinical Imaging

“…Son yıllarda, yeni tanı ajanları ile birlikte umut vaat eden radyoterapötik radyofarmasötiklerin kliniğe ulaşması, [Ra-223 diklorür (Xofigo; Bayer) ve Lu-177 DOTATATE (Lutathera; AAA)] yeni ve eski şirketlerin radyofarmasötik alanına girmesi moleküler görüntüleme komitesi tarafından bir rönesans olarak görülmüştür (16). FDA tarafından onaylanan F-18-fluciclovine, şüpheli tekrarlayan prostat kanserinin tespiti için, Cu-ATSM, F-18-FMISO bölgesel hipoksiyi haritalamak için en yaygın kullanılan PET ajanıdır (18,19,20). Prostat kanseri tedavisi için PSMA alfa yayıcı Ac-225 ile işaretlenmiş, ümit verici anti-tümör aktivitesi ile kastrasyona dirençli prostat kanserini tedavi etmek için kullanılmıştır.…”