Anti-3-[ ¹⁸ F]FACBC Positron Emission Tomography-Computerized Tomography and ¹¹¹ In-Capromab Pendetide Single Photon Emission Computerized Tomography-Computerized Tomography for Recurrent Prostate Carcinoma: Results of a Prospective Clinical Trial

Abstract

Purpose We prospectively evaluated the amino acid analogue positron emission tomography radiotracer anti-3-[18F]FACBC compared to ProstaScint® (111In-capromab pendetide) single photon emission computerized tomography-computerized tomography to detect recurrent prostate carcinoma. Materials and Methods A total of 93 patients met study inclusion criteria who underwent anti-3-[18F]FACBC positron emission tomography-computerized tomography plus 111In-capromab pendetide single photon emission computerized tomography-computerized tomography for suspected recurrent prostate carcinoma within 90 days. Reference standards were applied by a multidisciplinary board. We calculated diagnostic performance for detecting disease. Results In the 91 of 93 patients with sufficient data for a consensus on the presence or absence of prostate/bed disease anti-3-[18F]FACBC had 90.2% sensitivity, 40.0% specificity, 73.6% accuracy, 75.3% positive predictive value and 66.7% negative predictive value compared to 111In-capromab pendetide with 67.2%, 56.7%, 63.7%, 75.9% and 45.9%, respectively. In the 70 of 93 patients with a consensus on the presence or absence of extraprostatic disease anti-3-[18F]FACBC had 55.0% sensitivity, 96.7% specificity, 72.9% accuracy, 95.7% positive predictive value and 61.7% negative predictive value compared to 111In-capromabpendetide with10.0%, 86.7%, 42.9%, 50.0% and 41.9%, respectively. Of 77 index lesions used to prove positivity histological proof was obtained in 74 (96.1%). Anti-3-[18F]FACBC identified 14 more positive prostate bed recurrences (55 vs 41) and 18 more patients with extraprostatic involvement (22 vs 4). Anti-3-[18F]FACBC positron emission tomography-computerized tomography correctly up-staged 18 of 70 cases (25.7%) in which there was a consensus on the presence or absence of extraprostatic involvement. Conclusions Better diagnostic performance was noted for anti-3-[18F]FACBC positron emission tomography-computerized tomography than for 111In-capromab pendetide single photon emission computerized tomography-computerized tomography for prostate carcinoma recurrence. The former method detected significantly more prostatic and extraprostatic disease.

Impact of 18F-Fluciclovine PET on Target Volume Definition for Postprostatectomy Salvage Radiotherapy: Initial Findings from a Randomized Trial

“…The positivity criteria for 18 F-fluciclovine PET include persistent nonphysiologic moderate (greater than marrow) focal uptake in the prostate bed, lymph nodes, or bone (22,23).…”

“…In this context, 18 F-fluciclovine (anti-1-amino-3-18 F-fluorocyclobutane-1-carboxylic acid), which is transported in a manner similar to glutamine, has shown promising imaging characteristics for the detection of prostate cancer recurrence. 18 F-fluciclovine PET/CT has been compared with radioimmunoscintigraphy in a randomized trial and has shown significantly higher accuracy (22,23).…”

Update on 18F-Fluciclovine PET for Prostate Cancer Imaging

“…An analysis of 93 patients demonstrated an overall sensitivity, specificity, positive predictive value (PPV) and accuracy of 90.2%, 40.0%, 75.3%, 73.6% respectively (29). This series consisted of a relatively high proportion of patients who had undergone cryotherapy and brachytherapy, potentially leaving residual viable prostate tissue which may be more prone to confounding uptake due to inflammation or prostatic hypertrophy.…”

“…1] Not accounting for PSA levels or doubling times, the sensitivity, specificity, PPV, and accuracy of 18F-fluciclovine in detection of recurrent extraprostatic disease has been reported to be 55.0%, 96.7%, 95.7%, and 72.9% respectively (29). The multisite study of 596 patients by on May 10, 2018.…”

PET/CT imaging in cancer: Current applications and future directions

“…114 FACBC has been studied primarily in prostate cancer, in which it had higher sensitivity for tumor detection compared with 111 In-capromab pendetide (Prostascint) and 11 C-choline. 115,116 In addition, FACBC has demonstrated increased uptake in papillary renal cell carcinoma, but not in clear cell carcinoma. 117 FACBC is especially notable for the lack of associated radioactivity in the urine, which allows for better evaluation of the genitourinary tract and pelvis.…”