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A bicentric retrospective analysis of clinical utility of 18F-fluciclovine PET in biochemically recurrent prostate cancer following primary radiation therapy: is it helpful in patients with a PSA rise less than the Phoenix criteria?

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Abstract

Purpose

18F-Fluciclovine PET imaging has been increasingly used in the restaging of prostate cancer patients with biochemical recurrence (BCR); however, its clinical utility in patients with low prostate-specific antigen (PSA) levels following primary radiation therapy has not been well-studied. This study aims to determine the detection rate and diagnostic accuracy of 18F-fluciclovine PET and the patterns of prostate cancer recurrence in patients with rising PSA after initial radiation therapy, particularly in patients with PSA levels below the accepted Phoenix definition of BCR (PSA nadir +2 ng/mL).

Methods

This retrospective study included patients from two tertiary institutions who underwent 18F-fluciclovine PET scans for elevated PSA level following initial external beam radiation therapy, brachytherapy, and/or proton therapy. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to determine the diagnostic accuracy of 18F-fluciclovine PET and associations of PSA kinetic parameters with 18F-fluciclovine PET outcome.

Results

One hundred patients were included in this study. The overall detection rate on a patient-level was 79% (79/100). 18F-Fluciclovine PET was positive in 62% (23/37) of cases with PSA below the Phoenix criteria. The positive predictive value of 18F-fluciclovine PET was 89% (95% CI: 80–94%). In patients with PSA below the Phoenix criteria, the PSA velocity had the highest predictive value of 18F-fluciclovine PET outcome. PSA doubling time (PSADT) and PSA velocity were associated with the presence of extra-pelvic metastatic disease.

Conclusion

18F-Fluciclovine PET can identify recurrent disease at low PSA level and PSA rise below accepted Phoenix criteria in patients with suspected BCR after primary radiation therapy, particularly in patients with low PSADT or high PSA velocity. In patients with low PSADT or high PSA velocity, there is an increased probability of extra-pelvic metastases. Therefore, these patients are more likely to benefit from PET/CT or PET/MRI than pelvic MRI alone.

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Data availability

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Funding

Ali Salavati was supported by the Radiological Society of North America (RSNA) Research & Education Foundation, through grant number RR1963.The content is solely the responsibility of the authors and does notnecessarily represent the official views of the RSNA R&E Foundation.

Author information

Authors and Affiliations

  1. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA

    Ali Salavati & Steven P. Rowe

  2. Department of Radiology, University of Minnesota, Minneapolis, MN, USA

    Mehmet Gencturk, Yasemin Koksel, Allyssa N. Schik & Jerry W. Froelich

  3. Department of Urology, University of California, San Francisco, San Francisco, CA, USA

    Peter R. Carroll & Felix Y. Feng

  4. Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA

    Felix Y. Feng

  5. Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA

    Courtney Lawhn-Heath & Thomas A. Hope

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  1. Ali Salavati
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Correspondence to Ali Salavati.

Ethics declarations

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of University of California, San Francisco, and University of Minnesota approved this study.

Consent to participate

Informed consent was waived by the local Ethics Committee of University of California, San Francisco, and University of Minnesota in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care.

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Not applicable.

Conflict of interest

Ali Salavati, Mehmet Gencturk, Yasemin Koksel, Allyssa N. Schick, Steven P. Rowe, Courtney Lawhn-Heath, Jerry W. Froelich have no conflicts of interest to declare that are relevant to the content of this article. Thomas A. Hope served as a consultant toCurium and ITM and received research funding from Clovis and Philips. Thomas A. Hope also served on scientific advisory boards for Blue Earth, Ipsen. Peter R. Carroll served on an advisory board for Progenics. Felix Y. Feng has served as a consultant to Astellas, Bayer, Blue Earth, BMS, Exact Sciences, Foundation Medicine, Janssen, Myovant, Roivant, and Varian. Felix Y. Feng also serves on the scientifc advisoy boards of SerImmune and BlueStar Genomics.

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Salavati, A., Gencturk, M., Koksel, Y. et al. A bicentric retrospective analysis of clinical utility of 18F-fluciclovine PET in biochemically recurrent prostate cancer following primary radiation therapy: is it helpful in patients with a PSA rise less than the Phoenix criteria?. Eur J Nucl Med Mol Imaging 48, 4463–4471 (2021). https://doi.org/10.1007/s00259-021-05415-y

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