Diagnostic performance of 18F-fluciclovine PET/CT in prostate cancer patients with rising PSA level ≤ 0.5 ng/ml after multiple treatment failures

Ajalaya Teyateeti; Achiraya Teyateeti; Gregory C Ravizzini; Guofan Xu; Chad Tang; Shi-Ming Tu; Homer A Macapinlac; Yang Lu

Diagnostic performance of ¹⁸F-fluciclovine PET/CT in prostate cancer patients with rising PSA level ≤ 0.5 ng/ml after multiple treatment failures

Am J Nucl Med Mol Imaging. 2021 Apr 15;11(2):87-98. eCollection 2021.

Authors

Ajalaya Teyateeti^{1

2}, Achiraya Teyateeti³, Gregory C Ravizzini¹, Guofan Xu¹, Chad Tang⁴, Shi-Ming Tu⁵, Homer A Macapinlac¹, Yang Lu¹

Affiliations

¹ Department of Nuclear Medicine, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center Houston, TX, USA.
² Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand.
³ Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand.
⁴ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center Houston, TX, USA.
⁵ Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center Houston, TX, USA.

PMID: 34079638
PMCID: PMC8165728

Abstract

This retrospective study is to assess the performance of ¹⁸F-Fluciclovine PET/CT in prostate cancer (PC) patients with multiple treatment failures and prostate-specific antigen (PSA) ≤ 0.5 ng/mL. PC patients with multiple treatment failures who had PSA level within 2-week interval of ¹⁸F-Fluciclovine PET/CT (PSA_PET) ≤ 0.5 ng/mL were identified in retrospective review of our institution's database (n=28). Patient, tumor, treatment, PSA and castration characteristics as well as findings on ¹⁸F-Fluciclovine PET/CT were collected and compared between positive and negative ¹⁸F-Fluciclovine PET/CT subgroups by using Fisher's exact test. The overall detection rate of ¹⁸F-Fluciclovine PET/CT was 7 of 28 studies (25%). PSA_PET > 0.2 ng/mL was associated with higher detection rates in all (33.3 vs 10%, P=0.172), castration-resistant (CR) (50 vs 20%, P=0.343) and castration-sensitive (CS) (28.6 vs 0%, P=0.179) patients. Sites of recurrence were local 42.9% (3/7), nodal 42.9% (3/7) and bone metastases 14.3% (1/7). Higher Gleason score (GS 8-10) (33.3 vs 14.5%, P=0.396), advanced tumor stage (T3-T4) (35.7 vs 20%, P=0.653), second-line androgen deprivation therapy (ADT) uses (66.7 vs 20%, P=0.145), chemotherapy uses (50 vs 23.1%, P=0.444) and CRPC (33.3 vs 21.1%, P=0.483) related to positivity of ¹⁸F-Fluciclovine PET/CT but none reached statistical significance. Performance of ¹⁸F-Fluciclovine PET/CT in prostate cancer patients with multiple treatment failures and PSA_PET ≤ 0.5 ng/mL was acceptable particularly in patients with PSA_PET ≥ 0.3 ng/mL, CRPC, initial GS ≥ 8 or T3-T4.

Keywords: 18F-Fluciclovine; PET/CT; PSA; Prostate cancer; detection; recurrence.