18F-Fluciclovine Positron Emission Tomography in Men With Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy and Planning to Undergo Salvage Radiation Therapy: Results from LOCATE

Salvage Radiotherapy Management Decisions in Postprostatectomy Patients with Recurrent Prostate Cancer Based on 18F-Fluciclovine PET/CT Guidance

“…The whole-body positivity rate on 18 F-fluciclovine PET/CT was 79.7% in this study population, consistent with the reported positivity rates of 79.3% by Pernthaler (24) and 81% by Savir-Baruch (25). In contrast, relatively lower positivity rates on 18 F-fluciclovine PET/CT have been found by other studies (26,27), likely related to differences in mean PSA and PSA kinetics. Similar to other studies, we found that the detection rate of recurrent PCa on 18 F-fluciclovine PET/CT improves with increased PSA levels: 75.4% for PSA 1 ng/mL or lower and 90.9% for PSA higher than 1 ng/mL (19,25,28,29).…”

“…The lower management change found in our study is likely due to the homogeneous patient population, lower median PSA, exclusion of patients with evidence of extrapelvic disease on CI, and strict predefined major treatment changes. Comparable to our finding, Solanki et al reported a 48% management change after 18 F-fluciclovine PET/CT in 114 postprostatectomy patients with biochemical recurrence (median PSA, 0.42 ng/mL) intended to undergo radiotherapy (27).…”

Use and Impact of Positron Emission Tomography/Computed Tomography Prior to Salvage Radiation Therapy in Men with Biochemical Recurrence After Radical Prostatectomy: A Scoping Review

“…The notable differences in the detection rate and recurrence patterns between these two studies are surprising, given similar patient characteristics (median age 62 vs 66 yr, median Gleason score 7 vs 7), prescan PSA values (0.42 vs 0.43 ng/mL), and planned ADT use during salvage (39% vs 39%). However, the interquartile PSA range of 0.24-2.05 ng/ml was slightly higher in Jani [18] study than the range of 0.3-1.1 ng/ml in the Solanki [17] study, which may partially explain these differences. The differences might also be explained by the differential PET reading methodologies, which highlights the need for transparent, standardized, and reproducible PET reading protocols across centers.…”

“…A detailed examination of management changes was evaluated in the LOCATE subgroup study by Solanki et al [17]. At baseline, 70/114 (61%) patients in this study were planned for radiation to the prostate bed only, whereas 44/ 114 (39%) were planned to receive ADT with radiation.…”

“…LOCATE was a prospective, multicenter study investigating the impact of fluciclovine on the management of patients with BCR following definitive therapy. In a subset of 114 patients who had undergone RP and had no visible lesions on conventional imaging, fluciclovine identified a lesion in 48 (42%), at a median PSA level of 0.42 ng/mL [17]. Of the patients with identified lesions, 12/48 (25%) had disease in the prostatic fossa alone, another 12/48 (25%) had disease in the regional pelvic lymph nodes AE the prostatic fossa, and 24/48 (50%) had extrapelvic lesions.…”