fluciclovine-f-18 and Adenocarcinoma

Nonmetastatic castration-resistant prostate cancer (nmCRPC) presents a challenge to urologists as currently there are no Food and Drug Administration-approved therapies. However, there are new imaging modalities, including fluciclovine positron emission tomography-computed tomography and Ga-PSMA (prostate specific membrane antigent) positron emission tomography-computed tomography, which are improving accuracy of diagnosis. With improved imaging, we are better able to target therapy. Today there are 3 ongoing clinical trials studying second-generation antiandrogens in nmCRPC, which hold the promise of a new treatment paradigm. In this article, we will review the new imaging techniques and the rationale behind novel treatment modalities in nmCRPC.

Topics: Adenocarcinoma; Androgen Antagonists; Antineoplastic Agents, Hormonal; Benzamides; Biomarkers, Tumor; Bone Neoplasms; Carboxylic Acids; Clinical Trials, Phase III as Topic; Cyclobutanes; Disease Management; Drug Resistance, Neoplasm; Humans; Kallikreins; Male; Multicenter Studies as Topic; Nitriles; Orchiectomy; Phenylthiohydantoin; Prostate-Specific Antigen; Prostatic Neoplasms; Pyrazoles; Randomized Controlled Trials as Topic

Anti-1-amino-3-[(18)F]fluorocyclobutane-1-carboxylic acid (anti-3-[(18)F]FACBC) is a synthetic amino acid positron emission tomography (PET) radiotracer with utility in detection of prostate carcinoma and brain tumors and has also been shown to have uptake in lung tumor cell lines. The purpose of this study is to determine the uptake characteristics of anti-3-[(18)F]FACBC in lung carcinoma and if this radiotracer may help characterize pulmonary lesions.. Ten patients with pulmonary lesions scheduled for surgical resection or biopsy underwent 45-min dynamic PET-CT imaging of the thorax after IV injection of 214.6-384.8MBq of anti-3-[(18)F]FACBC. Anti-3-[(18)F]FACBC uptake was compared with that of routine 2-deoxy-2-[(18)F]fluoro-D-glucose ([(18)F]FDG) PET-CT scans of the same patient and validated with a combination of pathology, imaging and clinical follow-up. Immunohistochemistry for Ki-67 was performed on tissue samples.. There were nine malignant (seven lung nodules and two mediastinal nodes), two inflammatory, and one carcinoid lesion ranging from 1 to 3.75 cm. Mean(±SD) SUVmax of malignant lesions was 6.2(±2.6), 5.9(±2.7), 5.9(±3.4), and 5.7(±3.3), at 8, 16, 28, and 40 min, respectively; while for inflammatory lesions at the same time points, 4.1(±0.6), 3.3(±0.9), 2.2(±0.03), and 2.3(±0.03), respectively. The carcinoid tumor had SUVmax of 2.8, 2.6, 1.5, and 0.9 at similar time points. Mean SUVmax of all malignant lesions was higher than that of inflammatory lesions for anti-3-[(18)F]FACBC, and was statistically significant at greater than 28 min post-radiotracer infusion (p < 0.05). There was no significant correlation of anti-3-[(18)F]FACBC activity with Ki67, though there was a positive trend. There was a strong correlation between anti-3-[(18)F]FACBC and [(18)F]FDG uptake.. Anti-3-[(18)F]FACBC uptake in malignant lesions is greater than in inflammatory lesions with a higher degree of separation of uptake on delayed imaging. More comprehensive study is required to determine the diagnostic performance of anti-3-[(18)F]FACBC in the characterization of pulmonary lesions.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Carboxylic Acids; Cyclobutanes; Demography; Female; Humans; Ki-67 Antigen; Lung Neoplasms; Male; Middle Aged; Pilot Projects; Positron-Emission Tomography; Time Factors; Tomography, X-Ray Computed

Topics: Adenocarcinoma; Androstenes; Carboxylic Acids; Combined Modality Therapy; Cyclobutanes; Gonadotropin-Releasing Hormone; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Irradiation; Male; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prednisone; Prostate-Specific Antigen; Prostatic Neoplasms

A 71-year-old man with history of prostate cancer is evaluated for rising prostate-specific antigen. The patient also has a history of rectal well-differentiated neuroendocrine tumor. On F-fluciclovine PET/CT, 2 retroperitoneal lymph nodes exhibited intense fluciclovine avidity, whereas one enlarged perirectal lymph node only showed background uptake. On further Ga-DOTATATE PET/CT, the perirectal lymph node revealed intense DOTATATE avidity, whereas the 2 retroperitoneal lymph nodes only with similar to background DOTATATE avidity. Biopsy of the perirectal lymph node confirmed metastasis from neuroendocrine tumor. The distinct imaging characteristics of metastases from different primary malignancies correlated with their underlying different pathology.

Topics: Adenocarcinoma; Aged; Carboxylic Acids; Carcinoid Tumor; Cyclobutanes; Humans; Intestinal Neoplasms; Male; Neoplasm Metastasis; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Rectal Neoplasms

Meningiomas are the most common primary intracranial tumors. The current diagnosis and treatment of meningioma is dependent on computed tomography and magnetic resonance imaging, with follow-up management relying mainly on magnetic resonance imaging. The limitations of these structural imaging modalities include delineation of the tumor extent, tumor grade, and differentiation from other meningioma mimickers, especially in or around the skull base. Because studies with positron emission tomography (PET) have shown that PET is able to fulfill some of these gaps, the use of PET for meningiomas has been steadily increasing. Fluciclovine, also known as anti-1-amino-3-[. We present 3 cases of meningioma with avid uptake of fluciclovine. In each of these cases, the meningioma was incidentally found during surveillance using PET imaging in patients with prostate cancer.. These cases illustrate that this new radiotracer has the potential to be a complementary tool in the meningioma workup, treatment, and follow-up, especially for skull base lesions.

Topics: Adenocarcinoma; Aged; Carboxylic Acids; Cyclobutanes; Humans; Male; Meningeal Neoplasms; Meningioma; Neoplasms, Multiple Primary; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals