¹⁸F-Fluciclovine for the restaging of patients with biochemical recurrence of prostate cancer and the correlation with PSA values: Results from a single centre

Objectives: Early and accurate detection of the extent of local recurrence and of metastases in biochemical recurrence (BCR) of prostate cancer can inform therapy decisions when tumours are small and most amenable to localized therapy. ¹⁸F-Fluciclovine is a synthetic amino acid positron emission tomography (PET) radiotracer that is EMA- and FDA-approved for use in the detection of BCR of prostate cancer based on its encouraging histologically-confirmed diagnostic performance. Here, we report the experience from our clinic in evaluating the utility of ¹⁸F-fluciclovine PET/computed tomography (PET/CT) for the detection of lesions across a range of patients with suspected BCR of prostate cancer. Methods These data were obtained at the Catharina Hospital, Eindhoven, Netherlands from men who underwent ¹⁸F-fluciclovine PET/CT for suspected BCR of prostate cancer as part of a compassionate use program. Scans were conducted and images were interpreted according to standardized procedures. The most recent prostate-specific antigen (PSA) measurement before the ¹⁸F-fluciclovine PET/CT took place was recorded as the baseline PSA level for each patient. Detection rates (the proportion of scans containing one or more area considered positive for cancer) were stratified by baseline PSA levels and were also determined for the subject as well as regional levels. Results Between February and October 2017, 48 patients were scanned. One (2.1%) patient had a baseline PSA between 0.1 and 0.2 ng/mL, 9 (19%) patients >0.2-0.5, 4 (8.3%) patients >0.5-1.0, 6 (13%) patients >1.0-2.0, 14 (29%) patients >2.0-5.0, and 14 (29%) patients had a PSA level >5.0 ng/mL. ¹⁸F-Fluciclovine detected lesions in 37 (77%) patients; lesions were detected in the prostate/prostate bed and in pelvic lymph nodes in 19 (40%) and 16 (33%) patients, respectively. Metastatic involvement outside the pelvis was detected in 6 (13%) patient scans, while 10 (21%) scans showed lesions in skeletal sites. Generally, the detection rate increased with increasing baseline PSA, with detection rates of 0%, 78%, 75%, 50%, 86% and 93% among patients with baseline PSA levels in the range 0.1-0.2, >0.2-0.5, >0.5-1.0, >1.0-2.0, >2.0-5.0, and >5.0 ng/mL, respectively.Conclusions In line with previous studies, ¹⁸F-fluciclovine was able to sensitively detect BCR of prostate cancer, even at PSA levels ≤0.5 ng/mL. ¹⁸F-Fluciclovine PET/CT shows utility for the detection of disease in the prostate/bed, as well as in extraprostatic tissue and bone.