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18F-FACBC (anti1-amino-3-18F-fluorocyclobutane-1-carboxylic acid) versus 11C-choline PET/CT in prostate cancer relapse: results of a prospective trial

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Abstract

Purpose

To compare the accuracy of 18F-FACBC and 11C-choline PET/CT in patients radically treated for prostate cancer presenting with biochemical relapse.

Methods

This prospective study enrolled 100 consecutive patients radically treated for prostate cancer and presenting with rising PSA. Of these 100 patients, 89 were included in the analysis. All had biochemical relapse after radical prostatectomy (at least 3 months previously), had 11C-choline and 18F-FACBC PET/CT performed within 1 week and were off hormonal therapy at the time of the scans. The two tracers were compared directly in terms of overall positivity/negativity on both a per-patient basis and a per-site basis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated for both the tracers; follow-up at 1 year (including correlative imaging, PSA trend and pathology when available) was considered as the standard of reference.

Results

In 51 patients the results were negative and in 25 patients positive with both the tracers, in eight patients the results were positive with 18F-FACBC but negative with 11C-choline, and in five patients the results were positive with 11C-choline but negative with 18F-FACBC. Overall in 49 patients the results were false-negative (FN), in two true-negative, in 24 true-positive (TP) and in none false-positive (FP) with both tracers. In terms of discordances between the tracers: (1) in one patient, the result was FN with 11C-choline but FP with 18F-FACBC (lymph node), (2) in seven, FN with 11C-choline but TP with 18F-FACBC (lymph node in five, bone in one, local relapse in one), (3) in one, FP with 11C-choline (lymph node) but TP with 18F-FACBC (local relapse), (4) in two, FP with 11C-choline (lymph nodes in one, local relapse in one) but FN with 18F-FACBC, and (5) in three, TP with 11C-choline (lymph nodes in two, bone in one) but FN with 18F-FACBC. With 11C-choline and 18F-FACBC, sensitivities were 32 % and 37 %, specificities 40 % and 67 %, accuracies 32 % and 38 %, PPVs 90 % and 97 %, and NPVs 3 % and 4 %, respectively. Categorizing patients by PSA level (<1 ng/ml 28 patients, 1 – <2 ng/ml 28 patients, 2 – <3 ng/ml 11 patients, ≥3 ng/ml 22 patients), the number (percent) of patients with TP findings were generally higher with 18F-FACBC than with 11C-choline: six patients (21 %) and four patients (14 %), eight patients (29 %) and eight patients (29 %), five patients (45 %) and four patients (36 %), and 13 patients (59 %) and 11 patients (50 %), respectively.

Conclusion

18F-FACBC can be considered an alternative tracer superior to 11C-choline in the setting of patients with biochemical relapse after radical prostatectomy.

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Author notes

    Authors and Affiliations

    1. Nuclear Medicine, AOU Policlinico S.Orsola-Malpighi, Via Massarenti, 9 40138, Bologna, Italy

      Cristina Nanni, Lucia Zanoni, Filippo Lodi, Claudio Malizia, Cristina Fonti & Stefano Fanti

    2. Urology, AOU Policlinico S.Orsola-Malpighi, Bologna, Italy

      Cristian Pultrone, Riccardo Schiavina, Eugenio Brunocilla & Giuseppe Martorana

    3. Urology, Centro Avanzato di Urotecnologie, Istituto Auxologico Italiano , Presidio Ospedaliero Capitanio, Milan, Italy

      Matteo Ferrari & Patrizio Rigatti

    Authors
    1. Cristina Nanni
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    2. Lucia Zanoni
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    3. Cristian Pultrone
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    4. Riccardo Schiavina
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    5. Eugenio Brunocilla
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    Corresponding author

    Correspondence to Cristina Nanni.

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    Funding

    The project received a grant from “Programma di ricerca Regione-Università 2010-2012 della Regione Emilia Romagna – Bando giovani Ricercatori”.

    Conflicts of interest

    None.

    Ethical approval

    All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This Italian monocentric prospective protocol was approved by the Ethical Committee of S.Orsola-Malpighi Hospital.

    Informed consent

    All the enrolled patients signed specific informed consent.

    Additional information

    Cristina Nanni and Lucia Zanoni contributed equally to this work.

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    Nanni, C., Zanoni, L., Pultrone, C. et al. 18F-FACBC (anti1-amino-3-18F-fluorocyclobutane-1-carboxylic acid) versus 11C-choline PET/CT in prostate cancer relapse: results of a prospective trial. Eur J Nucl Med Mol Imaging 43, 1601–1610 (2016). https://doi.org/10.1007/s00259-016-3329-1

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    • DOI: https://doi.org/10.1007/s00259-016-3329-1

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