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?

Ali Salavati, Mehmet Gencturk, Yasemin Koksel, Allyssa N. Schik, Peter R. Carroll, Felix Y. Feng, Steven P. Rowe, Courtney Lawhn-Heath, Thomas A. Hope, Jerry W. Froelich

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Early online dateJun 6 2021
DOIs
StatePublished - Jun 6 2021

Bibliographical note

Funding Information:
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.

Funding Information:
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.

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Keywords

  • F-Fluciclovine
  • Biochemical recurrence
  • PET/CT
  • PET/MRI
  • Phoenix criteria
  • Prostate cancer
  • PSA
  • PSA doubling time

PubMed: MeSH publication types

  • Journal Article

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