18F]Fluciclovine PET/CT Improves the Clinical Management of Early Recurrence Prostate Cancer Patients.

Anna Giulia Nappi,Dino Rubini,Valentina Lavelli,Antonio Rosario Pisani,Angela Sardaro,Giuseppe Rubini,Cristina Ferrari,Paolo Mammucci

doi:10.3390/cancers14061461

Anna Giulia Nappi, Dino Rubini + Show 6 more

Open Access

https://doi.org/10.3390/cancers14061461

Copy DOI

Abstract

Simple SummaryIn the challenge between increasingly sensitive PET radiopharmaceuticals for the evaluation of prostate cancer patient in biochemical relapse, the choice of the most accurate PET tracer must be guided by literature data, but above all tailored to the patient’s profile. In describing our single-center experience, we aimed to identify biochemical and clinical–histological factors to be considered in patient selection and the semiquantitative parameters that can help the interpretation of malignant from benign lesions, in order to optimize the performance of this imaging method. These data in combination with a significant impact on therapeutic decision making can be useful to further validate the [18F]Fluciclovine PET/CT clinical application.We investigated the [18F]Fluciclovine PET/CT reliability in the early detection of recurrent prostate cancer (PCa) and its impact on therapeutic decision making. We retrospectively analyzed 58 [18F]Fluciclovine PET/CT scans performed to identify early PCa recurrence. Detection rate (DR) and semiquantitative analysis were evaluated in relation to biochemical and clinical–histological features. Clinical follow-up data were collected and considered as gold standard to evaluate sensitivity, specificity, accuracy, positive and negative predictive value (PPV, NPV). The impact of [18F]Fluciclovine PET/CT on clinical management was also assessed. Overall DR resulted as 66%, while DR was 53%, 28%, and 7% in prostate/bed, lymph nodes, and bone, respectively. DR significantly increased with higher PSA values (p = 0.009) and 0.45 ng/mL was identified as the optimal cut-off value. Moreover, SUVmax and SUVmean resulted significant parameters in interpreting malignant from benign findings. [18F]Fluciclovine PET/CT reached a sensitivity, specificity, PPV, NPV, and accuracy of 87.10%, 80.00%, 87.10%, 80.00%, and 84.31%, respectively. Therapeutic strategy was changed in 51% of patients. Our results support [18F]Fluciclovine PET/CT as a reliable tool for early restaging of PCa patients, especially for local recurrence detection, leading to a significant impact on clinical management. Semiquantitative analysis could improve specificity in interpreting malignant from benign lesions.

Highlights

Despite the improvement in surgical and radiation techniques for clinically localized prostate cancer (PCa), between 27% and 53% of all patients experience a rising prostatespecific antigen (PSA) level after curative-intent primary treatment [1].Nowadays, PCa relapse remains a diagnostic and therapeutic dilemma, since conventional imaging, including contrast-enhanced computed tomography (CT), Magnetic 4.0/).Resonance Imaging (MRI), and bone scan, often fail to early detect local tumor recurrence and to differentiate between local and systemic progression, especially at low PSA values [2,3]
Molecular imaging is being increasingly applied in the management of PCa patients in PSA relapse and innovative radiopharmaceuticals are being proposed in nuclear medicine scenarios to identify a low tumor burden disease with higher sensitivity at an earlier time
Molecular imaging is increasingly integrated in the diagnostic work-up of PCa patients imaging and facilitating earlier localization of recurrent disease [18]

Summary

Introduction

Despite the improvement in surgical and radiation techniques for clinically localized prostate cancer (PCa), between 27% and 53% of all patients experience a rising prostatespecific antigen (PSA) level after curative-intent primary treatment [1]. Resonance Imaging (MRI), and bone scan, often fail to early detect local tumor recurrence and to differentiate between local and systemic progression, especially at low PSA values [2,3]. Physicians frequently plan therapy based on clinical and pathological risk factors of disease progression, using standard consensus guidelines, instead of recurrence localization detected on imaging [1,4]. There is still no consensus on the optimal imaging modality for detecting small local recurrence in cases of low PSA levels. Molecular imaging is being increasingly applied in the management of PCa patients in PSA relapse and innovative radiopharmaceuticals are being proposed in nuclear medicine scenarios to identify a low tumor burden disease with higher sensitivity at an earlier time

Objectives

Methods

Findings

Conclusion