The Clinical Utility of 18F-Fluciclovine PET/CT in Biochemically Recurrent Prostate Cancer: an Academic Center Experience Post FDA Approval

Abstract

To evaluate the diagnostic performance and clinical utility of 18F-fluciclovine PET/CT in patients with biochemical recurrence (BCR) of prostate cancer (PC). 18F-Fluciclovine scans of 165 consecutive men with BCR after primary definitive treatment with prostatectomy (n\u2009=\u2009102) or radiotherapy (n\u2009=\u200963) were retrospectively evaluated. Seventy patients had concurrent imaging with at least one other conventional modality (CT (n\u2009=\u200931), MRI (n\u2009=\u200931), or bone scan (n\u2009=\u200926)). Findings from 18F-fluciclovine PET were compared with those from conventional imaging modalities. The positivity rate and impact of 18F-fluciclovine PET on patient management were recorded. In 33 patients who underwent at least one other PET imaging (18F-NaF PET/CT (n\u2009=\u200912), 68Ga-PSMA11 PET/CT (n\u2009=\u20095), 18F-DCFPyL PET/CT (n\u2009=\u200920), and 68Ga-RM2 PET/MRI (n\u2009=\u20095)), additional findings were evaluated. The overall positivity rate of 18F-fluciclovine PET was 67 %, which, as expected, increased with higher prostate-specific antigen (PSA) levels (ng/ml): 15 % (PSA\u2009<\u20090.5), 50 % (0.5\u2009≤\u2009PSA\u2009<\u20091), 56 % (1\u2009≤\u2009PSA\u2009<\u20092), 68 % (2\u2009≤\u2009PSA\u2009<\u20095), and 94 % (PSA\u2009≥\u20095), respectively. One hundred and two patients (62 %) had changes in clinical management based on 18F-fluciclovine PET findings. Twelve of these patients (12 %) had lesion localization on 18F-fluciclovine PET, despite negative conventional imaging. Treatment plans of 14 patients with negative 18F-fluciclovine PET were changed based on additional PET imaging with a different radiopharmaceutical. 18F-Fluciclovine PET/CT remains a useful diagnostic tool in the workup of patients with BCR PC, changing clinical management in 62 % of participants in our cohort.