Recurrent prostate cancer detection with anti-3-[F-18]FACBC PET/CT: comparison with CT

• Type of Material: Article
• Authors: Oluwaseun A. Odewole, Emory University; Funmilayo Tade, Emory University; Peter Nieh, Emory University; Bital Savir-Baruch, Loyola Univ; Ashesh Jani, Emory University; Viraj Master, Emory University; Peter Rossi, Emory University; Raghuveer Halkar, Emory University; Adeboye Osunkoya, Emory University; Oladunni Akin-Akintayo, Emory University; Chao Zhang, Emory University; Zhengjia Chen, Emory University; Mark Goodman, Emory University; David Schuster, Emory University
• Language: English
• Date: 2016-09-01
• Publisher: Springer Verlag
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016, Springer-Verlag Berlin Heidelberg.
• Final Published Version (URL): http://dx.doi.org/10.1007/s00259-016-3383-8
• Title of Journal or Parent Work: European Journal of Nuclear Medicine and Molecular Imaging
• ISSN: 1619-7070
• Volume: 43
• Issue: 10
• Start Page: 1773
• End Page: 1783
• Grant/Funding Information: David Schuster, Oluwaseun Odewole, Funmilayo Tade, Oladunni Akin-Akintayo. Although not impacting this study, funding is or has been received from Blue Earth Diagnostics Ltd. and Nihon Medi-Physics Co., Ltd. through the Emory University Office of Sponsored Projects for other clinical trials using FACBC (fluciclovine).; National Institutes of Health Grant (R01CA129356) and Georgia Cancer Coalition.
• Keywords: Radiology, Nuclear Medicine & Medical Imaging; BIOCHEMICAL RECURRENCE; FAILURE; LOCAL THERAPY; DISEASE; Life Sciences & Biomedicine; Science & Technology; Prostate cancer; CT; PET; RELAPSE; Diagnostic performance; CARCINOMA; COMPUTED-TOMOGRAPHY; Fluciclovine; RADIATION-THERAPY; ANTIGEN; FACBC; RADICAL PROSTATECTOMY
• Research Categories: Health Sciences, Radiology; Health Sciences, Medicine and Surgery

Abstract

Purpose: To compare the diagnostic performance of the synthetic amino acid analogue PET radiotracer anti-3-[ 18 F]FACBC (fluciclovine) with that of CT in the detection of recurrent prostate carcinoma. Methods: This was a retrospective analysis of 53 bone scan-negative patients with suspected recurrent prostate carcinoma who underwent fluciclovine PET/CT and routine clinical CT within 90 days of each other. The correlation between imaging findings and histology and clinical follow-up was evaluated. Positivity rates and diagnostic performance were calculated for fluciclovine PET/CT and CT. Results: Of 53 fluciclovine PET/CT and 53 CT examinations, 41 (77.4 %) and 10 (18.9 %), respectively, had positive findings for recurrent disease. Positivity rates were higher with fluciclovine PET/CT than with CT at all prostate-specific antigen (PSA) levels, PSA doubling times and original Gleason scores. In the prostate/bed, fluciclovine PET/CT was true-positive in 31 and CT was true-positive in 4 of 51 patients who met the reference standard. In extraprostatic regions, fluciclovine PET/CT was true-positive in 12 and CT was true-positive in 3 of 41 patients who met the reference standard. Of the 43 index lesions used to prove positivity, 42 (97.7 %) had histological proof. In 51 patients with sufficient follow-up to calculate diagnostic performance in the prostate/bed, fluciclovine PET/CT demonstrated a sensitivity of 88.6 %, a specificity of 56.3 %, an accuracy of 78.4 %, a positive predictive value (PPV) of 81.6 %, and a negative predictive value (NPV) of 69.2 %; the respective values for CT were 11.4 %, 87.5 %, 35.3 %, 66.7 % and 31.1 %. In 41 patients with sufficient follow-up to calculate diagnostic performance in extraprostatic regions, fluciclovine PET/CT demonstrated a sensitivity of 46.2 %, a specificity of 100 %, an accuracy of 65.9 %, a PPV of 100 %, and an NPV of 51.7 %; the respective values for CT were 11.5 %, 100 %, 43.9 %, 100 % and 39.5 %. Conclusion: The diagnostic performance of fluciclovine PET/CT in recurrent prostate cancer is superior to that of CT and fluciclovine PET/CT provides better delineation of prostatic from extraprostatic recurrence.