Detectability Rates and Impact on Management From High-Sensitivity Total-Body 18F-Fluciclovine PET/CT Scans in Patients With Prostate Cancer Biochemical Recurrence

S. Azghadi, Y. Abdelhafez, M. Parikh, M. Stephen, B. M. Usera, M. Dall'Era, R. Badawi, S. Cherry, X. Zhao, F. Şen, L. Nardo, Richard K Valicenti

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE/OBJECTIVE(S): 18F-fluciclovine, an FDA-approved synthetic amino acid radiopharmaceutical for assessment of prostate cancer (PCa) recurrence, may show modest lesion detectability rates on conventional PET/CT scanners, especially for low PSA levels (< 30%). A total-body PET/CT scanner can provide high-sensitivity imaging and may provide unique opportunity for detecting lower disease burden. In this pilot work, we explored the lesion detectability rates from 18F-fluciclovine total-body PET/CT in patients with biochemically recurrent PCa and impact on therapeutic decisions. MATERIALS/METHODS: A single-institution, prospective IRB-approved study was conducted. From December 2019 to February 2021, 21 patients (age, 69.7 ± 7.5 yrs) with history of PCa, treated with radical prostatectomy (n = 18), external beam radiation therapy (n = 2) or brachytherapy (n = 1), subsequently presented with biochemical recurrence by American Urological Association criteria. All patients had standard of care18F-fluciclovine total-body PET/CT scans after a negative or equivocal cross-sectional conventional imaging. PET/CT images were interpreted on patient- and site-basis for any suspicious recurrent/metastatic lesions (prostate bed, N1, M1). Detection rate was measured as percentage per PSA category. A decision regarding treatment was recorded before and after 18F-fluciclovine PET/CT results and changes were noted. RESULTS: Fifteen (71%) patients showed detectable lesions in 24 sites: the prostate bed/seminal vesicles (n = 8), N1 station (n = 7), and M1 (n = 9). The latter included M1a (n = 3), M1b (n = 1) and M1c (n = 5) in different combinations. On a patient basis, detection rates were 2/4 (50%), 4/5 (80%), 2/4 (50%), 2/3 (67%) and 5/5 (100%) for the respective PSA categories of < 0.2, 0.2-0.5, 0.51-1.00, 1.01-2.00 and > 2.00 ng/mL. Overall, detection rate was 10/16 (63%) for PSA < 2 ng/mL (compared to published rates of 26% for fluciclovine and 56%for PSMA). Treatment decisions were changed in 18/21 (87%) of patients in the form of conversion to focal ablative radiation therapy (n = 13, 62%), systemic therapy (n = 2, 10%), or active surveillance (n = 1, 5%) or change in the currently received systemic therapy (n = 2, 10%). CONCLUSION: Preliminary results demonstrated a promising role for high-sensitivity total-body PET/CT imaging using 18F-fluciclovine in patients with biochemically recurrent prostate cancer. In this small cohort, detection rates compared favorably to the published historical controls using fluciclovine or even PSMA on conventional PET/CT scanners. The current findings resulted in impactful changes of management in the majority of patients. A larger study is ongoing to validate the current findings.

Original languageEnglish (US)
Pages (from-to)e264-e265
JournalInternational journal of radiation oncology, biology, physics
Volume111
Issue number3
DOIs
StatePublished - Nov 1 2021

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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