fluciclovine-f-18 and Neoplasm-Metastasis

Topics: Carboxylic Acids; Cyclobutanes; Diagnosis, Differential; Humans; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals

Prostate cancer is a very heterogeneous disease, and contemporary management is focused on identification and treatment of the prognostically adverse high-risk tumors while minimizing overtreatment of indolent, low-risk tumors. In recent years, imaging has gained increasing importance in the detection, staging, posttreatment assessment, and detection of recurrence of prostate cancer. Several imaging modalities including conventional and functional methods are used in different clinical scenarios with their very own advantages and limitations. This continuing medical education article provides an overview of available imaging modalities currently in use for prostate cancer followed by a more specific section on the value of these different imaging modalities in distinct clinical scenarios, ranging from initial diagnosis to advanced, metastatic castration-resistant prostate cancer. In addition to established imaging indications, we will highlight some potential future applications of contemporary imaging modalities in prostate cancer.

Topics: Aged; Antigens, Surface; Carboxylic Acids; Choline; Cyclobutanes; Disease Progression; Fluorodeoxyglucose F18; Glutamate Carboxypeptidase II; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Multiparametric Magnetic Resonance Imaging; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostatic Neoplasms; Prostatic Neoplasms, Castration-Resistant; Radionuclide Imaging; Theranostic Nanomedicine; Tomography, X-Ray Computed; Whole Body Imaging

PET is a functional imaging method that can exploit various aspects of tumor biology to enable greater detection of prostate cancer than can be provided by morphologic imaging alone. Anti-1-amino-3-

Topics: Aged; Carboxylic Acids; Cyclobutanes; Humans; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Radiotherapy Planning, Computer-Assisted; Sensitivity and Specificity; Up-Regulation

In the past, positron emission tomography (PET) has played a relatively limited role in prostate cancer imaging. However, in recent years, several new PET tracers have emerged, offering potential improvements in diagnostic performance for both the detection of prostate cancer metastases at initial staging and the localization of recurrent disease.. We reviewed the literature for prostate cancer PET tracers that are either being used for patient management or being evaluated in clinical research trials. For each tracer, we compiled clinically relevant background information and evidence supporting clinical use, with the intention of providing a high-yield primer for urologists managing patients with prostate cancer.. 18F-FDG, 18F-NaF, ¹¹C-choline, and 18F-fluciclovine have all proven useful for prostate cancer imaging, though the utility of each of these tracers is limited to targeted management questions and particular clinical settings. In contrast, the newer prostate-specific membrane antigen (PSMA) agents may prove useful as general purpose PET tracers for prostate cancer imaging. Numerous other novel PET tracers have shown promising results in pre-clinical studies.. Basic knowledge of these PET tracers, specifically their strengths, weaknesses, and indications for use, is essential to urologists and other physicians caring for patients with prostate cancer.

Topics: Antigens, Surface; Carbon Radioisotopes; Carboxylic Acids; Cyclobutanes; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Glutamate Carboxypeptidase II; Humans; Male; Neoplasm Metastasis; Positron-Emission Tomography; Prostatic Neoplasms; Radioactive Tracers; Radiopharmaceuticals; Sodium Fluoride

Only few patients with PSA relapse after radical treatment will show clinically detectable disease. Although the natural history of recurrent prostate cancer is often one of the slowly progressing diseases, in some men it can be rapid and may need a salvage treatment. In general, time to PSA relapse, PSA velocity and PSA doubling time are useful in patient assesment. In patients with PCa disease relapse after primary therapy, salvage treatment for a local recurrence should only be offered to patients with little risk of already having metastases. In these patients a systemic imaging negative for metastases is mandatory, a positive biopsy is not always necessary before radiotherapy, but is mandatory before salvage prostatectomy. In patients with a high risk of distant metastases and suitable for systemic salvage therapy, a positive lesion must be obviously visualized with one of the currently available imaging techniques. Transrectal ultrasound has low accuracy in the detection of the recurrence. Multiparametric Magnetic Resonance Imaging may have a role in the early phase of PSA relapse. Conventional imaging, such as bone scan and CT, are not suggested in the initial phase of BCR. Today, it has been reported that PET/CT allows changing the therapeutic strategy (from palliative to curative treatment and vice-versa) in about 20% of cases. In recent years, the new radiotracer 18F-FACBC has been proposed as a possible alternative radiopharmaceutical to detect PCa relapse. The aim of the present paper is to evaluate the management of patients with BCR after radical treatment of PCa from the urologist point of view.

Topics: Bone Neoplasms; Carbon Radioisotopes; Carboxylic Acids; Choline; Cyclobutanes; Fluorine Radioisotopes; Humans; Male; Multimodal Imaging; Neoplasm Metastasis; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Tomography, X-Ray Computed

Laparoscopic port-site metastasis from prostate cancer is a rare complication after radical prostatectomy and pelvic lymph node dissection. We report a case of port-site metastasis from prostate cancer identified on 18F-fluciclovine PET/CT for a patient with evidence of biochemical recurrence. Final pathology after targeted ultrasound and biopsy of the mass in the right abdominal wall revealed prostatic adenocarcinoma.

Topics: Aged; Biopsy; Carboxylic Acids; Cyclobutanes; Humans; Laparoscopy; Male; Middle Aged; Neoplasm Metastasis; Positron Emission Tomography Computed Tomography; Prostatectomy; Prostatic Neoplasms

A 66-year-old man was diagnosed with metastatic prostate cancer to the bones. The patient started Ra-dichloride (Xofigo) therapy in April 2019. Tc-MDP bone scan and F-fluciclovine (Axumin) PET/CT showed discordant but overall complementary findings that indicated disease progression after 5 doses of Xofigo therapy. The patient's prostate-specific antigen increased from 33.81 ng/mL at baseline before Xofigo therapy and up to 394.3 ng/mL after the fifth dose of Xofigo treatment. Because of disease progression, Xofigo therapy was discontinued.

Topics: Aged; Bone and Bones; Carboxylic Acids; Cyclobutanes; Humans; Male; Neoplasm Metastasis; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms, Castration-Resistant; Radioisotopes; Radium

The aim of the study was to assess the diagnostic performance of fluciclovine positron emission tomography (PET)/computerized tomography (CT) in post-radical prostatectomy prostate cancer patients with rising prostate-specific antigen (PSA) ≤0.5 ng/mL, and identify the associated predictive factors of positive studies.. From 30 June 2017 to 9 August 2019, patients with post-radical prostatectomy prostate cancer who underwent F-18 fluciclovine PET/CT and had PSA level within 2-week interval (PSAPET) ≤0.5 ng/mL were enrolled into this single-institution retrospective study. Data on tumor characteristics, including Gleason scores, extra-prostatic extension, seminal vesicle invasion, surgical margin and nodal metastasis, PSA after radical prostatectomy, previous hormonal therapy, PSA doubling time (PSADT), scanner type, PSAPET and site of recurrence were collected. Comparison of these factors between groups of positive and negative fluciclovine PET/CT was done by using Mann-Whitney U-test and Fisher's exact test.. Of 94 eligible patients with post-radical prostatectomy prostate cancer, 10 patients had positive studies (10.6%). Detection rate at PSAPET 0.1, 0.2, 0.3, 0.4 and 0.5 ng/mL were 0% (0/11), 0% (0/15), 20% (6/30), 4% (1/25) and 23.1% (3/13), respectively. Upon multivariate analysis of clinical factors, only a PSADT <3 months (P = 0.023) was shown to have a statistically significant correlation with a positive study.. In post-radical prostatectomy prostate cancer patients with rising PSA 0.1-0.5 ng/mL, the sensitivity of F-18 fluciclovine PET/CT for identifying tumor recurrence/metastases is poor with an overall detection rate of 10.6%. Larger prospective studies are required to validate these findings.

Topics: Aged; Aged, 80 and over; Carboxylic Acids; Cyclobutanes; Humans; Male; Middle Aged; Neoplasm Metastasis; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Retrospective Studies

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

Topics: Carbon Radioisotopes; Carboxylic Acids; Choline; Cyclobutanes; Humans; Male; Molecular Imaging; Neoplasm Metastasis; Neoplasm Recurrence, Local; Prostate-Specific Antigen; Prostatic Neoplasms; Radiopharmaceuticals; Time Factors

Diagnosing bone metastases with traditional anatomic modalities, such as MRI and CT, is limited by sensitivity, and conventional bone radiotracers are only indirect markers of cancer activity. Fortunately, molecular imaging is uniquely capable of providing radiotracers such as fluciclovine and radiolabeled choline, that actually target tumors in the bone. The merits of research in imaging osseous metastases in animal models using these radiotracers and the implications for future clinical translation are discussed.

Topics: Animals; Bone Neoplasms; Carboxylic Acids; Cyclobutanes; Disease Models, Animal; Molecular Imaging; Neoplasm Metastasis; Positron-Emission Tomography

Topics: Animals; Bone Neoplasms; Breast Neoplasms; Carboxylic Acids; Cyclobutanes; Disease Models, Animal; Male; Neoplasm Metastasis; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Rats

We assessed the rate of detection rate of recurrent prostate cancer by PET/CT using anti-3-(18)F-FACBC, a new synthetic amino acid, in comparison to that using (11)C-choline as part of an ongoing prospective single-centre study.. Included in the study were 15 patients with biochemical relapse after initial radical treatment of prostate cancer. All the patients underwent anti-3-(18)F-FACBC PET/CT and (11)C-choline PET/CT within a 7-day period. The detection rates using the two compounds were determined and the target-to-background ratios (TBR) of each lesion are reported.. No adverse reactions to anti-3-(18)F-FACBC PET/CT were noted. On a patient basis, (11)C-choline PET/CT was positive in 3 patients and negative in 12 (detection rate 20%), and anti-3-(18)F-FACBC PET/CT was positive in 6 patients and negative in 9 (detection rate 40%). On a lesion basis, (11)C-choline detected 6 lesions (4 bone, 1 lymph node, 1 local relapse), and anti-3-(18)F-FACBC detected 11 lesions (5 bone, 5 lymph node, 1 local relapse). All (11)C-choline-positive lesions were also identified by anti-3-(18)F-FACBC PET/CT. The TBR of anti-3-(18)F-FACBC was greater than that of (11)C-choline in 8/11 lesions, as were image quality and contrast.. Our preliminary results indicate that anti-3-(18)F-FACBC may be superior to (11)C-choline for the identification of disease recurrence in the setting of biochemical failure. Further studies are required to assess efficacy of anti-3-(18)F-FACBC in a larger series of prostate cancer patients.

Topics: Aged; Carbon Radioisotopes; Carboxylic Acids; Choline; Cyclobutanes; Humans; Limit of Detection; Male; Middle Aged; Multimodal Imaging; Neoplasm Metastasis; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Radiopharmaceuticals; Tomography, X-Ray Computed

Topics: Aged; Carboxylic Acids; Cyclobutanes; Humans; Male; Multimodal Imaging; Neoplasm Metastasis; Positron-Emission Tomography; Prostatic Neoplasms; Tomography, X-Ray Computed

Conventional imaging techniques have serious limitations in the detection, staging, and restaging of prostate carcinoma. Anti-1-amino-3-(18)F-fluorocyclobutane-1-carboxylic acid (anti-(18)F-FACBC)is a synthetic l-leucine analog that has excellent in vitro uptake within the DU-145 prostate carcinoma cell line and orthotopically implanted prostate tumor in nude rats. There is little renal excretion compared with (18)F-FDG. The present study examines anti-(18)F-FACBC uptake in patients with newly diagnosed and recurrent prostate carcinoma.. Fifteen patients with a recent diagnosis of prostate carcinoma (n = 9) or suspected recurrence (n = 6) underwent 65-min dynamic PET/CT of the pelvis after intravenous injection of 300-410 MBq anti-(18)F-FACBC followed by static body images. Each study was evaluated qualitatively and quantitatively. Maximum standardized uptake values were recorded in the prostate or prostate bed, and within lymph nodes at 4.5 min (early) and 20 min (delayed), and correlated with clinical, imaging and pathologic follow-up. Time-activity curves were also generated for benign and malignant tissue.. In the 8 patients with newly diagnosed prostate carcinoma who underwent dynamic scanning, visual analysis correctly identified the presence or absence of focal neoplastic involvement in 40 of 48 prostate sextants. Pelvic nodal status correlated with anti-(18)F-FACBC findings in 7 of 9 patients and was indeterminate in 2 of 9. In all 4 patients in whom there was proven recurrence, visual analysis was successful in identifying disease (1 prostate bed, 3 extraprostatic). In 3 of these patients, (111)In-capromab-pendetide had no significant uptake at nodal and skeletal foci. Malignant lymph node uptake in both the staging and restaging patients was significantly higher than benign nodal uptake. Though uptake faded with time, in all 6 patients with either lymph node metastases or recurrent prostate bed carcinoma, there was intense persistent uptake at 65 min.. Anti-(18)F-FACBC is a promising radiotracer for imaging prostate carcinoma. Radiotracer uptake was demonstrated in primary and metastatic disease. Future research should investigate the mechanism of radiotracer uptake in normal and pathologic tissue and develop a clinical imaging strategy for initial staging and restaging.

Topics: Aged; Carboxylic Acids; Cyclobutanes; Humans; Image Processing, Computer-Assisted; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Metastasis; Positron-Emission Tomography; Prostate; Prostatic Neoplasms; Radiometry; Recurrence; Time Factors; Tomography, X-Ray Computed