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Recurrent prostate cancer detection with anti-3-[18F]FACBC PET/CT: comparison with CT

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Abstract

Purpose

To compare the diagnostic performance of the synthetic amino acid analogue PET radiotracer anti-3-[18F]FACBC (fluciclovine) with that of CT in the detection of recurrent prostate carcinoma.

Methods

This was a retrospective analysis of 53 bone scan-negative patients with suspected recurrent prostate carcinoma who underwent fluciclovine PET/CT and routine clinical CT within 90 days of each other. The correlation between imaging findings and histology and clinical follow-up was evaluated. Positivity rates and diagnostic performance were calculated for fluciclovine PET/CT and CT.

Results

Of 53 fluciclovine PET/CT and 53 CT examinations, 41 (77.4 %) and 10 (18.9 %), respectively, had positive findings for recurrent disease. Positivity rates were higher with fluciclovine PET/CT than with CT at all prostate-specific antigen (PSA) levels, PSA doubling times and original Gleason scores. In the prostate/bed, fluciclovine PET/CT was true-positive in 31 and CT was true-positive in 4 of 51 patients who met the reference standard. In extraprostatic regions, fluciclovine PET/CT was true-positive in 12 and CT was true-positive in 3 of 41 patients who met the reference standard. Of the 43 index lesions used to prove positivity, 42 (97.7 %) had histological proof. In 51 patients with sufficient follow-up to calculate diagnostic performance in the prostate/bed, fluciclovine PET/CT demonstrated a sensitivity of 88.6 %, a specificity of 56.3 %, an accuracy of 78.4 %, a positive predictive value (PPV) of 81.6 %, and a negative predictive value (NPV) of 69.2 %; the respective values for CT were 11.4 %, 87.5 %, 35.3 %, 66.7 % and 31.1 %. In 41 patients with sufficient follow-up to calculate diagnostic performance in extraprostatic regions, fluciclovine PET/CT demonstrated a sensitivity of 46.2 %, a specificity of 100 %, an accuracy of 65.9 %, a PPV of 100 %, and an NPV of 51.7 %; the respective values for CT were 11.5 %, 100 %, 43.9 %, 100 % and 39.5 %.

Conclusion

The diagnostic performance of fluciclovine PET/CT in recurrent prostate cancer is superior to that of CT and fluciclovine PET/CT provides better delineation of prostatic from extraprostatic recurrence.

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References

  1. Schiavina R, Brunocilla E, Borghesi M, Vagnoni V, Castellucci P, Nanni C, et al. Diagnostic imaging work-up for disease relapse after radical treatment for prostate cancer: how to differentiate local from systemic disease? The urologist point of view. Rev Esp Med Nucl Imagen Mol. 2013;32(5):310–3. doi:10.1016/j.remn.2013.06.003.

    CAS  PubMed  Google Scholar 

  2. Beresford MJ, Gillatt D, Benson RJ, Ajithkumar T. A systematic review of the role of imaging before salvage radiotherapy for post-prostatectomy biochemical recurrence. Clin Oncol (R Coll Radiol). 2010;22(1):46–55. doi:10.1016/j.clon.2009.10.015.

    Article  CAS  Google Scholar 

  3. Boukaram C, Hannoun-Levi JM. Management of prostate cancer recurrence after definitive radiation therapy. Cancer Treat Rev. 2010;36(2):91–100. doi:10.1016/j.ctrv.2009.06.006.

    Article  PubMed  Google Scholar 

  4. Jager GJ, Ruijter E, Van de Kaa C, de la Rosette J, Oosterhof G, Thornbury JR, et al. Local staging of prostate cancer with endorectal MR imaging: correlation with histopathology. AJR Am J Roentgenol. 1996;166(4):845–52.

    Article  CAS  PubMed  Google Scholar 

  5. Kramer S, Gorich J, Gottfried HW, Riska P, Aschoff AJ, Rilinger N, et al. Sensitivity of computed tomography in detecting local recurrence of prostatic carcinoma following radical prostatectomy. Br J Radiol. 1997;70(838):995–9. doi:10.1259/bjr.70.838.9404201.

    Article  CAS  PubMed  Google Scholar 

  6. Kane CJ, Amling CL, Johnstone PA, Pak N, Lance RS, Thrasher JB, et al. Limited value of bone scintigraphy and computed tomography in assessing biochemical failure after radical prostatectomy. Urology. 2003;61(3):607–11.

    Article  PubMed  Google Scholar 

  7. Oyen RH, Van Poppel HP, Ameye FE, Van de Voorde WA, Baert AL, Baert LV. Lymph node staging of localized prostatic carcinoma with CT and CT-guided fine-needle aspiration biopsy: prospective study of 285 patients. Radiology. 1994;190(2):315–22. doi:10.1148/radiology.190.2.8284375.

    Article  CAS  PubMed  Google Scholar 

  8. Zukotynski K, Haider MA. Imaging in prostate carcinoma. Hematol Oncol Clin North Am. 2013;27(6):1163–87. doi:10.1016/j.hoc.2013.08.003.

    Article  PubMed  Google Scholar 

  9. Beer AJ, Eiber M, Souvatzoglou M, Schwaiger M, Krause BJ. Radionuclide and hybrid imaging of recurrent prostate cancer. Lancet Oncol. 2011;12(2):181–91. doi:10.1016/s1470-2045(10)70103-0.

    Article  PubMed  Google Scholar 

  10. Schiavina R, Ceci F, Borghesi M, Brunocilla E, Vagnoni V, Gacci M, et al. The dilemma of localizing disease relapse after radical treatment for prostate cancer: which is the value of the actual imaging techniques? Curr Radiopharm. 2013;6(2):92–5.

    Article  CAS  PubMed  Google Scholar 

  11. Evangelista L, Zattoni F, Guttilla A, Saladini G, Zattoni F, Colletti PM, et al. Choline PET or PET/CT and biochemical relapse of prostate cancer: a systematic review and meta-analysis. Clin Nucl Med. 2013;38(5):305–14. doi:10.1097/RLU.0b013e3182867f3c.

    Article  PubMed  Google Scholar 

  12. Ceci F, Castellucci P, Graziani T, Schiavina R, Brunocilla E, Mazzarotto R, et al. 11C-choline PET/CT detects the site of relapse in the majority of prostate cancer patients showing biochemical recurrence after EBRT. Eur J Nucl Med Mol Imaging. 2014;41(5):878–86. doi:10.1007/s00259-013-2655-9.

    Article  CAS  PubMed  Google Scholar 

  13. Odewole OA, Oyenuga OA, Tade F, Savir-Baruch B, Nieh PT, Master V, et al. Reproducibility and reliability of anti-3-[18F]FACBC uptake measurements in background structures and malignant lesions on follow-up PET-CT in prostate carcinoma: an exploratory analysis. Mol Imaging Biol. 2015;17(2):277–83. doi:10.1007/s11307-014-0797-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Schuster DM, Nieh PT, Jani AB, Amzat R, Bowman FD, Halkar RK, et al. Anti-3-[(18)F]FACBC positron emission tomography-computerized tomography and (111)In-capromab pendetide single photon emission computerized tomography-computerized tomography for recurrent prostate carcinoma: results of a prospective clinical trial. J Urol. 2014;191(5):1446–53. doi:10.1016/j.juro.2013.10.065.

    Article  PubMed  Google Scholar 

  15. Schuster DM, Savir-Baruch B, Nieh PT, Master VA, Halkar RK, Rossi PJ, et al. Detection of recurrent prostate carcinoma with anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid PET/CT and 111In-capromab pendetide SPECT/CT. Radiology. 2011;259(3):852–61. doi:10.1148/radiol.11102023.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Turkbey B, Mena E, Aras O, Garvey B, Grant K, Choyke PL. Functional and molecular imaging: applications for diagnosis and staging of localised prostate cancer. Clin Oncol (R Coll Radiol). 2013;25(8):451–60. doi:10.1016/j.clon.2013.05.001.

    Article  CAS  Google Scholar 

  17. Kairemo K, Rasulova N, Partanen K, Joensuu T. Preliminary clinical experience of trans-1-amino-3-(18)F-fluorocyclobutanecarboxylic acid (anti-(18)F-FACBC) PET/CT imaging in prostate cancer patients. Biomed Res Int. 2014;2014:305182. doi:10.1155/2014/305182.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Okudaira H, Oka S, Ono M, Nakanishi T, Schuster DM, Kobayashi M, et al. Accumulation of trans-1-amino-3-[(18)F]fluorocyclobutanecarboxylic acid in prostate cancer due to androgen-induced expression of amino acid transporters. Mol Imaging Biol. 2014;16(6):756–64. doi:10.1007/s11307-014-0756-x.

    Article  PubMed  Google Scholar 

  19. McConathy J, Yu W, Jarkas N, Seo W, Schuster DM, Goodman MM. Radiohalogenated nonnatural amino acids as PET and SPECT tumor imaging agents. Med Res Rev. 2012;32(4):868–905. doi:10.1002/med.20250.

    Article  CAS  PubMed  Google Scholar 

  20. McConathy J, Voll RJ, Yu W, Crowe RJ, Goodman MM. Improved synthesis of anti-[18F]FACBC: improved preparation of labeling precursor and automated radiosynthesis. Appl Radiat Isot. 2003;58(6):657–66.

    Article  CAS  PubMed  Google Scholar 

  21. Epstein JI, Zelefsky MJ, Sjoberg DD, Nelson JB, Egevad L, Magi-Galluzzi C, et al. A contemporary prostate cancer grading system: a validated alternative to the Gleason score. Eur Urol. 2016;69(3):428–35. doi:10.1016/j.eururo.2015.06.046.

    Article  PubMed  Google Scholar 

  22. Talab SS, Preston MA, Elmi A, Tabatabaei S. Prostate cancer imaging: what the urologist wants to know. Radiol Clin N Am. 2012;50(6):1015–41. doi:10.1016/j.rcl.2012.08.004.

    Article  PubMed  Google Scholar 

  23. Choueiri TK, Dreicer R, Paciorek A, Carroll PR, Konety B. A model that predicts the probability of positive imaging in prostate cancer cases with biochemical failure after initial definitive local therapy. J Urol. 2008;179(3):906–10. doi:10.1016/j.juro.2007.10.059.

    Article  PubMed  Google Scholar 

  24. Ferguson JK, Oesterling JE. Patient evaluation if prostate-specific antigen becomes elevated following radical prostatectomy or radiation therapy. Urol Clin North Am. 1994;21(4):677–85.

    CAS  PubMed  Google Scholar 

  25. Mamede M, Ceci F, Castellucci P, Schiavina R, Fuccio C, Nanni C, et al. The role of 11C-choline PET imaging in the early detection of recurrence in surgically treated prostate cancer patients with very low PSA level <0.5 ng/mL. Clin Nucl Med. 2013;38(9):342–5. doi:10.1097/RLU.0b013e31829af913.

    Article  Google Scholar 

  26. Hovels AM, Heesakkers RA, Adang EM, Jager GJ, Strum S, Hoogeveen YL, et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol. 2008;63(4):387–95. doi:10.1016/j.crad.2007.05.022.

    Article  CAS  PubMed  Google Scholar 

  27. Zaorsky NG, Raj GV, Trabulsi EJ, Lin J, Den RB. The dilemma of a rising prostate-specific antigen level after local therapy: what are our options? Semin Oncol. 2013;40(3):322–36. doi:10.1053/j.seminoncol.2013.04.011.

    Article  PubMed  Google Scholar 

  28. Bouchelouche K, Turkbey B, Choyke P, Capala J. Imaging prostate cancer: an update on positron emission tomography and magnetic resonance imaging. Curr Urol Rep. 2010;11(3):180–90. doi:10.1007/s11934-010-0105-9.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Oyama N, Miller TR, Dehdashti F, Siegel BA, Fischer KC, Michalski JM, et al. 11C-acetate PET imaging of prostate cancer: detection of recurrent disease at PSA relapse. J Nucl Med. 2003;44(4):549–55.

    CAS  PubMed  Google Scholar 

  30. Avanesov M, Karul M, Derlin T. (68)Ga-PSMA as a new tracer for evaluation of prostate cancer: comparison between PET-CT and PET-MRI in biochemical recurrence. Radiologe. 2015;55(2):89–91. doi:10.1007/s00117-014-2792-6.

    Article  CAS  PubMed  Google Scholar 

  31. Treglia G, Ceriani L, Sadeghi R, Giovacchini G, Giovanella L. Relationship between prostate-specific antigen kinetics and detection rate of radiolabelled choline PET/CT in restaging prostate cancer patients: a meta-analysis. Clin Chem Lab Med. 2014;52(5):725–33. doi:10.1515/cclm-2013-0675.

    Article  CAS  PubMed  Google Scholar 

  32. Chen J, Zhao Y, Li X, Sun P, Wang M, Wang R, et al. Imaging primary prostate cancer with 11C-choline PET/CT: relation to tumour stage, Gleason score and biomarkers of biologic aggressiveness. Radiol Oncol. 2012;46(3):179–88. doi:10.2478/v10019-012-0034-y.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Cimitan M, Evangelista L, Hodolic M, Mariani G, Baseric T, Bodanza V, et al. Gleason score at diagnosis predicts the rate of detection of 18F-choline PET/CT performed when biochemical evidence indicates recurrence of prostate cancer: experience with 1,000 patients. J Nucl Med. 2015;56(2):209–15. doi:10.2967/jnumed.114.141887.

    Article  CAS  PubMed  Google Scholar 

  34. Okotie OT, Aronson WJ, Wieder JA, Liao Y, Dorey F, De KJ, et al. Predictors of metastatic disease in men with biochemical failure following radical prostatectomy. J Urol. 2004;171(6 Pt 1):2260–4.

    Article  PubMed  Google Scholar 

  35. Nanni C, Schiavina R, Brunocilla E, Boschi S, Borghesi M, Zanoni L, et al. 18F-Fluciclovine PET/CT for the detection of prostate cancer relapse: a comparison to 11C-choline PET/CT. Clin Nucl Med. 2015;40(8):e386–91. doi:10.1097/rlu.0000000000000849.

    Article  PubMed  Google Scholar 

  36. Johnstone PA, Tarman GJ, Riffenburgh R, Rohde DC, Puckett ML, Kane CJ. Yield of imaging and scintigraphy assessing biochemical failure in prostate cancer patients. Urol Oncol. 1997;3(4):108–12.

    Article  CAS  PubMed  Google Scholar 

  37. Schuster DM, Taleghani PA, Nieh PT, Master VA, Amzat R, Savir-Baruch B, et al. Characterization of primary prostate carcinoma by anti-1-amino-2-[(18)F] -fluorocyclobutane-1-carboxylic acid (anti-3-[(18)F] FACBC) uptake. Am J Nucl Med Mol Imaging. 2013;3(1):85–96.

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Turkbey B, Mena E, Shih J, Pinto PA, Merino MJ, Lindenberg ML, et al. Localized prostate cancer detection with 18F FACBC PET/CT: comparison with MR imaging and histopathologic analysis. Radiology. 2014;270(3):849–56. doi:10.1148/radiol.13130240.

    Article  PubMed  Google Scholar 

  39. Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B, et al. Evaluation of hybrid 68Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med. 2015;56(5):668–74. doi:10.2967/jnumed.115.154153.

    Article  PubMed  Google Scholar 

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Acknowledgments

We acknowledge the significant contributions of Rianot Amzat, MD, Pooneh Taleghani, MD, Delicia Votaw, CNMT, Fenton G. Ingram, RT(R), CNMT, PET, Seraphinah Lawal, RT(R), CNMT, PET, Adam Brown, RT(N), CNMT, Ronald J. Crowe, RPh, BCNP, and the entire cyclotron and synthesis team from the Emory Center for Systems Imaging, Beverly Hunter, RN, Michelle Faurot, BS, James R. Galt, PhD, John R. Votaw, PhD, our research nurse Leah-Madge Bellamy, RN, MSN, and Pardeep Mittal, MD, who provided professional and technical information on conventional imaging protocols.

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Authors and Affiliations

  1. Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA

    Oluwaseun A. Odewole, Funmilayo I. Tade, Raghuveer K. Halkar, Oladunni Akin-Akintayo, Mark M. Goodman & David M. Schuster

  2. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road, Atlanta, GA, 30322, USA

    David M. Schuster

  3. Urology, Emory University, Atlanta, GA, USA

    Peter T. Nieh, Viraj A. Master & Adeboye O. Osunkoya

  4. Radiology, Loyola University Medical Centre, Maywood, IL, USA

    Bital Savir-Baruch

  5. Radiation Oncology, Emory University, Atlanta, GA, USA

    Ashesh B. Jani & Peter J. Rossi

  6. Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA

    Adeboye O. Osunkoya

  7. Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Chao Zhang & Zhengjia Chen

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  1. Oluwaseun A. Odewole
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  2. Funmilayo I. Tade
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  3. Peter T. Nieh
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  4. Bital Savir-Baruch
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  8. Raghuveer K. Halkar
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  9. Adeboye O. Osunkoya
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  13. Mark M. Goodman
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  14. David M. Schuster
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Corresponding author

Correspondence to David M. Schuster.

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Funding

This study was funded by a grant from the National Institutes of Health (R01CA129356) and by the Georgia Cancer Coalition.

Additional information

Oluwaseun A. Odewole and Funmilayo I. Tade are co-first authors.

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Odewole, O.A., Tade, F.I., Nieh, P.T. et al. Recurrent prostate cancer detection with anti-3-[18F]FACBC PET/CT: comparison with CT. Eur J Nucl Med Mol Imaging 43, 1773–1783 (2016). https://doi.org/10.1007/s00259-016-3383-8

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