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

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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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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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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  • DOI: https://doi.org/10.1007/s00259-016-3383-8

Keywords

  • FACBC
  • Fluciclovine
  • CT
  • PET
  • Prostate cancer
  • Diagnostic performance