Diagnostic performance of F-18 fluciclovine PET/CT in post-radical prostatectomy prostate cancer patients with rising prostate-specific antigen level ≤0.5 ng/mL

Abstract

Purpose The aim of the study was to assess the diagnostic performance of fluciclovine positron emission tomography (PET)/computerized tomography (CT) in post-radical prostatectomy prostate cancer patients with rising prostate-specific antigen (PSA) ≤0.5 ng/mL, and identify the associated predictive factors of positive studies. Patients and methods From 30 June 2017 to 9 August 2019, patients with post-radical prostatectomy prostate cancer who underwent F-18 fluciclovine PET/CT and had PSA level within 2-week interval (PSAPET) ≤0.5 ng/mL were enrolled into this single-institution retrospective study. Data on tumor characteristics, including Gleason scores, extra-prostatic extension, seminal vesicle invasion, surgical margin and nodal metastasis, PSA after radical prostatectomy, previous hormonal therapy, PSA doubling time (PSADT), scanner type, PSAPET and site of recurrence were collected. Comparison of these factors between groups of positive and negative fluciclovine PET/CT was done by using Mann–Whitney U-test and Fisher’s exact test. Results Of 94 eligible patients with post-radical prostatectomy prostate cancer, 10 patients had positive studies (10.6%). Detection rate at PSAPET 0.1, 0.2, 0.3, 0.4 and 0.5 ng/mL were 0% (0/11), 0% (0/15), 20% (6/30), 4% (1/25) and 23.1% (3/13), respectively. Upon multivariate analysis of clinical factors, only a PSADT <3 months (P = 0.023) was shown to have a statistically significant correlation with a positive study. Conclusion In post-radical prostatectomy prostate cancer patients with rising PSA 0.1–0.5 ng/mL, the sensitivity of F-18 fluciclovine PET/CT for identifying tumor recurrence/metastases is poor with an overall detection rate of 10.6%. Larger prospective studies are required to validate these findings.

68Ga-PSMA-11 PET Identified Tumor Recurrence in Prostatectomy Bed With Rising PSA of 0.9 ng/mL but Negative on MRI and 18F-Fluciclovine PET Scan

“…4 The diagnostic performance of 18 F-fluciclovine PET/CT in recurrent prostate cancer patients with PSA level <0.2 ng/mL had reported sensitivity of 42.9% in local recurrence. 5 As shown in this case, the PSMA PET image identified local disease recurrence in the prostatectomy bed from a patient with low PSA level. Although the urine activity within the bladder may confound recurrent tumor, the greater tumor-to-background contrast on the 68 Ga-PSMA-11 PET images improves the lesion detection rate.…”

“…A recent prospective, single-center, open-label, single-arm comparative study demonstrated the PSMA should be the PET tracer of choice for prostate cancer patients with biochemical recurrence after radical prostatectomy and low PSA concentrations (≤2.0 ng/mL) 4 . The diagnostic performance of 18 F-fluciclovine PET/CT in recurrent prostate cancer patients with PSA level <0.2 ng/mL had reported sensitivity of 42.9% in local recurrence 5 . As shown in this case, the PSMA PET image identified local disease recurrence in the prostatectomy bed from a patient with low PSA level.…”

Diagnostic Performance of PSMA-Based 18F-DCFPyL PET/CT in Prostate Cancer Patients After Definitive Treatment With PSA Level ≤0.2 ng/mL

“…As shown in Figure 2, local recurrent PC can be detected on 18 F-DCFPyL PET/CT with PSA level of <0.1 ng/mL. Comparing to our previously reported 0%–11.8% positive detection rate in fluciclovine PET/CT with concurrent PSA level of ≤0.2 ng/mL, 36–38 the higher detection rate in 18 F-DCFPyL PET/CT is suggestive of better sensitivity, concordant with other published data comparing 68 Ga-PSMA-11 with fluciclovine PET/CT 39,40 …”

18F-Fluciclovine PET Detected Early Tumor Recurrence in Prostatectomy Bed With Low PSA of 0.3 ng/mL But Negative on 18F-PSMA PET Scan

“…Fluciclovine PET/CT has been reported to have detection rates of 21.4% to 41.4% in recurrent prostate cancer with PSA level ≤1 ng/mL 1–3 . The diagnostic performance of 18 F-fluiclovine PET/CT in recurrent prostate cancer patients with PSA <0.2 ng/mL had reported sensitivity of 42.9% in local recurrence 4 . Fluciclovine PET/CT has shown similar diagnostic performance with pelvic mpMRI in detecting recurrent/metastatic prostate disease in the pelvis in the setting of rising PSA after initial treatment 5 .…”

“…The lesion had typic MRI features of diffusion restriction (arrows in A and B), T2 hypointense signal (arrow in C), and avid enhancement post contrast (arrow in D), confirmed as tumor recurrence.Fluciclovine PET/CT has been reported to have detection rates of 21.4% to 41.4% in recurrent prostate cancer with PSA level ≤1 ng/mL [1][2][3]. The diagnostic performance of 18 F-fluiclovine PET/CT in recurrent prostate cancer patients with PSA <0.2 ng/mL had reported sensitivity of 42.9% in local recurrence 4. Fluciclovine PET/CT has shown similar diagnostic performance with pelvic mpMRI in detecting recurrent/metastatic prostate disease in the pelvis in the setting of rising PSA after initial treatment.5 In the presence of undetectable PSA after definitive treatment, fluciclovine PET/CT would benefit most to patients with Gleason score of 7 or higher, high disease burden, and the ones who have history of second-line androgen deprivation therapy and/or chemotherapy.6 There are reports about the superiority of PSMA PET over fluciclovine PET.…”