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

• 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
• Journal Title: European Journal of Nuclear Medicine and Molecular Imaging
• Volume: Volume 43, Number 10
• Publisher: Springer Verlag | 2016-09-01, Pages 1773-1783
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1007/s00259-016-3383-8
• Subjects: Health Sciences, Radiology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Radiology, Nuclear Medicine & Medical Imaging; FACBC; Fluciclovine; CT; PET; Prostate cancer; Diagnostic performance; RADICAL PROSTATECTOMY; BIOCHEMICAL RECURRENCE; COMPUTED-TOMOGRAPHY; RADIATION-THERAPY; LOCAL THERAPY; CARCINOMA; RELAPSE; FAILURE; DISEASE; ANTIGEN

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.