Abstract
782
Objectives: A review of our experience with implementing 18F-Fluciclovine Positron Emission Tomography (PET) imaging (FACBC, Axumin®) for detection of suspected recurrent prostate cancer. US Food and Drug Administration (FDA) approval of this PET tracer presents an opportunity to image a new patient population who previously rarely benefited from standard 18F-Fludeoxyglucose (FDG) PET imaging.
Methods: The imaging procedure for FACBC is quite different than FDG. With essentially no wait for uptake time, FACBC imaging should begin within 3 to 5 minutes post tracer injection. This presents some difficulties for PET facilities that primarily image FDG oncology patients. The short uptake time requires the patient to be injected while on the imaging table which impacts scheduling of other patients who require a 60 minute uptake period. Hence, you are forced to eliminate a patient slot in the 60 min prior to the FACBC patient. Another consideration is that scheduling is also dependent upon availability of the tracer, which is currently limited both on production dates and production sites. This access barrier to the radiopharmaceutical presents challenges in meeting the patient demand for this exam and in some markets the availability of the exam completely. It is also important to consider both the equipment and layout needed in the scanning room to perform a successful FACBC injection and scan. Positioning the FACBC patient for injection and scan is also an important consideration. It is important to center the prostate gland/prostate bed in the first bed position due to the fact there is rapid urinary excretion of this tracer into the bladder. Modern PET/CT scanners use the topogram to define the PET scan field-of-view, which defines the starting point of the first bed position. For most technologists familiar with standard FDG-PET oncology imaging (skull base to mid-thigh), the first bed position of an FACBC scan is much higher on the upper thigh and unlike FDG there is no second chance to reposition if you incorrectly started the image.
Results: Since we have started offering this study clinically in early November 2016, our volume has increased modestly (approximately one per week). This is in part due to the fact Medicare coverage did not start until January 2017 and private insurers are slow to approve this new imaging agent. Both, the amount of inquiries from referring physicians, and recent Medicare approval leads us to anticipate a significant increase in the number of prostate cancer patients that will be imaged at our facility. With practice, our patient prep is now producing high quality, reproducible images, which are important for the referring physicians to provide patient and disease specific treatment options to this patient population. Referring physicians have expressed appreciation for a new way to evaluate and more accurately treat their patients.
Conclusion: With the exception of 18F-Sodium Fluoride (NaF) PET imaging of the bones for high risk patients or those with known aggressive disease, PET imaging for prostate cancer patients has been rare. With the introduction of 18F-Fluciclovine to the market and the continued interest in prostate specific membrane antigen agents (PSMA) the role of PET imaging in prostate cancer is sure to dramatically shift the number and type of patients currently seen in a PET department.