Abstract
PET is a functional imaging method that can exploit various aspects of tumor biology to enable greater detection of prostate cancer than can be provided by morphologic imaging alone. Anti-1-amino-3-18F-flurocyclobutane-1-carboxylic acid (18F-fluciclovine) is a nonnaturally occurring amino acid PET radiotracer that was recently approved by the U.S. Food and Drug Administration for detection of suspected recurrent prostate cancer. The tumor-imaging features of this radiotracer mirror the upregulation of transmembrane amino acid transport that occurs in prostate cancer because of increased amino acid metabolism for energy and protein synthesis. This continuing medical education article provides an overview on 18F-fluciclovine PET diagnostic capabilities for primary and metastatic disease, including reviews of published comparisons to conventional imaging and other molecular imaging agents. Additionally, the imaging procedure and image interpretation are detailed, including physiologic and pathologic uptake patterns and pitfalls.
Footnotes
Published online Mar. 9, 2018.
Learning Objectives: On successful completion of this activity, participants should be able to describe (1) clinical indications for fluciclovine PET and accuracy for local and metastatic disease; (2) fluciclovine PET imaging protocol optimization; and (3) correct interpretation of local and metastatic disease and benign physiologic variants.
Financial Disclosure: The authors receive support from R01CA129356, R01CA121320, P50CA128301, R01CA204254, R01CA169188, RO1CA156755, R21CA176684, and U01CA113913, as well as from the Emory Winship Comprehensive Cancer Center and the Glenn Family Breast Center. Emory University is eligible to receive royalties from 18F-fluciclovine. Ephraim E. Parent and David M. Schuster have participated in sponsored research involving 18F-fluciclovine through the Emory University Office of Sponsored Projects, including funding from Blue Earth Diagnostics, Ltd., and Nihon Medi-Physics Co., Ltd. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest.
CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through May 2021.
- © 2018 by the Society of Nuclear Medicine and Molecular Imaging.