Prospective evaluation of fluciclovine (F-18) PET-CT and MRI in detection of recurrent prostate cancer in non-prostatectomy patients

• Type of Material: Article
• Authors: Oladunni Akin-Akintayo, Emory University; Funmilayo Tade, Emory University; Pardeep Mittal, Emory University; Carlos Moreno, Emory University; Peter T Nieh, Emory University; Peter J Rossi, Emory University; Dattatraya Patil, Emory University; Raghuveer Halkar, Emory University; Baowei Fei, Emory University; Viraj Master, Emory University; Ashesh Jani, Emory University; Hiroumi Kitajima, Emory University; Adeboye O. Osunkoya, Emory University; Claudia Ormenisan-Gherasim, Emory University; Mark Goodman, Emory University; David M Schuster, Emory University
• Language: English
• Date: 2018-05-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier B.V.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ejrad.2018.02.006
• Title of Journal or Parent Work: European Journal of Radiology
• ISSN: 0720-048X
• Volume: 102
• Start Page: 1
• End Page: 8
• Grant/Funding Information: This study was funded by National Institutes of Health (NIH P50 CA12830, R21CA176684, R01CA156775 and R01CA204254).; Blue Earth Diagnostics Ltd. provided fluciclovine synthesis cassettes to Emory University for this project.
• Keywords: ACID; Science & Technology; GA-68-PSMA; LIGAND; BIOCHEMICAL RECURRENCE; C-11-CHOLINE PET/CT; Prostate cancer; CARCINOMA; TOMOGRAPHY; Multiparametric MRI; Fluciclovine; Life Sciences & Biomedicine; PET-CT; Radiology, Nuclear Medicine & Medical Imaging
• Research Categories: Health Sciences, Pathology; Health Sciences, Radiology; Health Sciences, Oncology

Abstract

Purpose: To investigate the disease detection rate, diagnostic performance and interobserver agreement of fluciclovine ( 18 F) PET-CT and multiparametric magnetic resonance imaging (mpMR) in recurrent prostate cancer. Methods: Twenty-four patients with biochemical failure after non-prostatectomy definitive therapy, 16/24 of whom had undergone brachytherapy, underwent fluciclovine PET-CT and mpMR with interpretation by expert readers blinded to patient history, PSA and other imaging results. Reference standard was established via a multidisciplinary truth panel utilizing histology and clinical follow-up (22.9 ± 10.5 months) and emphasizing biochemical control. The truth panel was blinded to investigative imaging results. Diagnostic performance and interobserver agreement (kappa) for the prostate and extraprostatic regions were calculated for each of 2 readers for PET-CT (P1 and P2) and 2 different readers for mpMR (M1 and M2). Results: On a whole body basis, the detection rate for fluciclovine PET-CT was 94.7% (both readers), while it ranged from 31.6–36.8% for mpMR. Kappa for fluciclovine PET-CT was 0.90 in the prostate and 1.0 in the extraprostatic regions. For mpMR, kappa was 0.25 and 0.74, respectively. In the prostate, 22/24 patients met the reference standard with 13 malignant and 9 benign results. Sensitivity, specificity and positive predictive value (PPV) were 100.0%, 11.1% and 61.9%, respectively for both PET readers. For mpMR readers, values ranged from 15.4–38.5% for sensitivity, 55.6–77.8% for specificity and 50.0–55.6% for PPV. For extraprostatic disease determination, 18/24 patients met the reference standard. Sensitivity, specificity and PPV were 87.5%, 90.0% and 87.5%, respectively, for fluciclovine PET-CT, while for mpMR, sensitivity ranged from 50 to 75%, specificity 70–80% and PPV 57–75%. Conclusion: The disease detection rate for fluciclovine PET-CT in non-prostatectomy patients with biochemical failure was 94.7% versus 31.6–36.8% for mpMR. For extraprostatic disease detection, fluciclovine PET-CT had overall better diagnostic performance than mpMR. For the treated prostate, fluciclovine PET-CT had high sensitivity though low specificity for disease detection, while mpMR had higher specificity, though low sensitivity. Interobserver agreement was also higher with fluciclovine PET-CT compared with mpMR.