fluciclovine-f-18 and Prostatic-Neoplasms

To systematically assess the early detection rate of biochemical prostate cancer recurrence using choline, fluciclovine, and PSMA.. Under the guidance of the Preferred Reporting Items for Systematic reviews and Meta-Analysis Diagnostic Test Accuracy guidelines, literature that assessed the detection rates (DRs) of choline, fluciclovine, and PSMA in prostate cancer biochemical recurrence was searched in PubMed and EMBASE databases for our systematic review from 2012 to July 15, 2021. In addition, the PSA-stratified performance of detection positivity was obtained to assess the DRs for various methods, including fluciclovine, PSMA, or choline PET/CT, with respect to biochemical recurrence based on different PSA levels.. The DRs of PSMA-radiotracers were greater than those of choline-radiotracers and fluciclovine-radiotracers at the patient level.. • The DRs of PSMA-radiotracers were greater than those of choline-radiotracers and fluciclovine-radiotracers at the patient level. •

Topics: Choline; Gallium Radioisotopes; Humans; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms

18F-Fluciclovine PET is approved for the evaluation of patients with suspected prostate cancer recurrence. 18F-Fluciclovine PET is highly specific for the localization of extraprostatic disease even with negative conventional images and low prostate-specific antigen and has been reported to influence patients' management and improve outcome. With the recent Food and Drug Administration approval of prostate-specific membrane antigen (PSMA) PET, 18F-Fluciclovine is likely to be used as an adjunct modality in patients with suspected occult local recurrence and/or negative PSMA findings.

Topics: Carboxylic Acids; Cyclobutanes; Humans; Male; Positron Emission Tomography Computed Tomography; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms

The PET tracer

Topics: Carboxylic Acids; Cyclobutanes; Humans; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Reference Standards

Prostate-specific membrane antigen (PSMA)-targeted radiopharmaceuticals are playing a large role at the time of initial staging and biochemical recurrence for localizing prostate cancer, as well as in other emerging clinical settings. PSMA PET has demonstrated increased detection rate compared with conventional imaging and has been shown to change management plans in a substantial percentage of cases. The aims of this narrative review are to highlight the development and clinical impact of PSMA PET radiopharmaceuticals, to compare PSMA to other agents such as fluorine 18 fluciclovine and carbon 11 choline, and to highlight some of the individual PSMA PET agents that have contributed to the advancement of prostate cancer imaging.

Topics: Carbon Radioisotopes; Carboxylic Acids; Choline; Cyclobutanes; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Male; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Radiopharmaceuticals

Topics: Carboxylic Acids; Cyclobutanes; Humans; Male; Neoplasm Recurrence, Local; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Radiopharmaceuticals

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

Conventional imaging modalities have been poor in characterizing the true extent of disease in men with biochemical recurrence following primary treatment for prostate cancer. Functional imaging with positron emission tomography (PET) has shown promise of being a superior imaging modality. We conducted a systematic review and meta-analysis to define the diagnostic accuracy of PET/CT using 11C-choline, 18F-FACBC, or 68Ga-PSMA in detecting recurrent prostate cancer.. We searched multiple databases in line with the preferred reporting items for systematic review and meta-analysis (PRISMA) statement to define the diagnostic accuracy of 11C-choline, 18F-FACBC, or 68Ga-PSMA PET/CT. Only studies secondarily staging participants with biochemical recurrence and those with an appropriate reference standard (pathology, further imaging, and/or clinical response) were eligible for analysis.. Twenty-one studies with 3202 participants met the inclusion criteria. Of these, 11C-choline, 18F-FACBC, and 68Ga-PSMA were the tracer investigated in 16, 5, and 1 studies, respectively. The summary sensitivity for each tracer was 80.9% (95% CI 70.4-88.3%), 79.7% (95% CI 51.9-93.4%), and 76.4% (95% CI 68.3-82.9%), respectively. The corresponding summary specificity was 84.1% (95% CI 70.2-92.2%), 61.9% (95% CI 41.1-79.0%), and 99.8% (95% CI 97.5-100%), respectively. Detection rates ranged between 58.6 and 82.8%. All included studies were judged to be at high risk of bias primarily due to study limitations pertaining to the reference standard.. There is a lack of high-quality data to verify the accuracy of PET-based imaging using 11C-choline, 18F-FACBC, or 68Ga-PSMA. The early results are encouraging that these techniques are superior to conventional imaging modalities, which would allow salvage therapies to be optimized.

Topics: Carbon Radioisotopes; Carboxylic Acids; Choline; Cyclobutanes; Gallium Isotopes; Gallium Radioisotopes; Humans; Male; Membrane Glycoproteins; Neoplasm Recurrence, Local; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Radiopharmaceuticals

Positron emission tomography/computed tomography (PET/CT) has recently emerged as a promising diagnostic imaging platform for prostate cancer. Several radiolabelled tracers have demonstrated efficacy for cancer detection in various clinical settings. In this review, we aim to illustrate the diverse use of PET/CT with different tracers for the detection of prostate cancer.. NaF PET/CT has shown efficacy in detecting bone metastases with high sensitivity, but relatively low specificity. Currently, choline PET/CT has been the most extensively studied modality. Although having superior specificity, choline PET/CT suffers from low sensitivity, especially at low PSA levels. Nevertheless, choline PET/CT was found to significantly improve upon conventional imaging modalities (CIM) in the detection of metastatic lesions at biochemical recurrence (BCR). Newer methods using fluciclovine and PSMA-targeted radiotracers have preliminarily demonstrated great promise in primary and recurrent staging of prostate cancer. However, their superior efficacy awaits confirmation in larger series.. PET/CT has emerged as a promising staging modality for both primary and recurrent prostate cancer. Newer tracers have increased detection accuracies for small, incipient metastatic foci. The clinical implications of these occult PET/CT detected disease foci require organized evaluation. Efforts should be aimed at defining their natural history as well as responsiveness and impact of metastasis-directed therapy.

Topics: Carboxylic Acids; Choline; Cyclobutanes; Humans; Male; Multimodal Imaging; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Radioactive Tracers

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

A significant number of patients radically treated for prostate cancer (PCa) will develop prostate-specific antigen recurrence (27-53%). Localizing the anatomical site of relapse is critical, in order to achieve the optimal treatment management. To date the diagnostic accuracy of standard imaging is low. Several desirable features have been identified for the amino-acid-based PET agent, fluciclovine (

Topics: Carboxylic Acids; Contrast Media; Cyclobutanes; Humans; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Radiopharmaceuticals

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

Prostate cancer is the most common cancer and the second leading cause of cancer death in men in the United States. Despite high prevalence, diagnosis and surveillance is limited due to indolent biology. Functional imaging techniques improved the ability to detect disease. Amino acids are building blocks of proteins and intracellular transport is upregulated in prostate cancer. Normal biodistribution patterns of fluciclovine include uptake in the liver and pancreas with minimal to no urine excretion, a distinct advantage for prostate cancer imaging. This review provides a detailed overview of the use of F-18 fluciclovine PET in prostate cancer imaging.

Topics: Carboxylic Acids; Cyclobutanes; Humans; Male; Positron-Emission Tomography; Prostatic Neoplasms; Sensitivity and Specificity; Tomography, X-Ray Computed

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

The detection of neoplastic lymph nodal involvement in prostate cancer (PCa) patients has relevant therapeutic and prognostic significance, both in the clinical settings of primary staging and restaging. Lymph nodal dissection (LND) currently represents the gold standard for evaluating the presence of lymph nodal involvement. However, this procedure is invasive, associated with morbidity, and may fail in detecting all potential lymph nodal metastatic regions. Currently the criteria for lymph nodal detection using conventional imaging techniques mainly rely on morphological assessment with unsatisfactory diagnostic accuracy. Positron emission tomography (PET) represents a helpful imaging technique for a proper staging of lymph nodal status. The most investigated PET radiotracer is choline, although many others have been explored as guide for both primary and salvage LND, such as fluorodeoxyglucose, acetate, fluorocyclobutanecarboxylic acid and prostate-specific membrane antigen. In the present review, a comprehensive literature review addressing the role of PET for LND in PCa patients is reported, with the use of the above-mentioned radiotracers.

Topics: Acetates; Carbon Radioisotopes; Carboxylic Acids; Choline; Cyclobutanes; Edetic Acid; Fluorodeoxyglucose F18; Gallium Isotopes; Gallium Radioisotopes; Humans; Lymph Node Excision; Lymph Nodes; Magnetic Resonance Imaging; Male; Multimodal Imaging; Neoplasm Staging; Oligopeptides; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostatectomy; Prostatic Neoplasms; Radiopharmaceuticals

Prostate cancer is the most common cancer and the second leading cause of cancer death in men in the United States. Despite high disease prevalence, diagnosis and surveillance of the disease with conventional imaging are limited typically because of indolent biology. Functional imaging with advanced molecular techniques improves the ability to detect disease. Amino acids are building blocks of proteins, and intracellular transport of amino acids is upregulated in prostate cancer. This review provides a detailed overview of the use of F-18 fluciclovine PET in prostate cancer imaging.

Topics: Bone Neoplasms; Carboxylic Acids; Cyclobutanes; Drug Approval; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Multimodal Imaging; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Postoperative Care; Practice Guidelines as Topic; Prostatectomy; Prostatic Neoplasms; Radiopharmaceuticals; Tomography, X-Ray Computed

Nuclear medicine can play an important role in evaluating prostate cancer combining anatomical and functional information with hybrid techniques. Various PET radiopharmaceuticals have been used for targeting specific biological markers in prostate cancer. Research is ideally oriented towards the development of radiopharmaceuticals targeting antigens overexpressed in prostate cancer, as opposed to normal prostate tissue. In this regard, gastrin-releasing peptide receptors (GRPR) are excellent candidates. Bombesin analogues targeting the GRPR have been investigated. Gallium-68 (

Topics: Antigens, Surface; Bombesin; Carbon Radioisotopes; Carboxylic Acids; Choline; Cyclobutanes; Fluorodeoxyglucose F18; Forecasting; Gallium Radioisotopes; Glutamate Carboxypeptidase II; Humans; Male; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Receptors, Bombesin

Anti-1-amino-3-[18F]fluorocyclobutane-1-carboxylic acid (anti-3-18F-FACBC) positron emission tomography/computed tomography (PET/CT), 11 C-choline PET/CT, 111In-capromab pendetide, and T2-weighted magnetic resonance imaging (MRI) have been used for detecting prostate carcinoma relapse.. To systematically review and perform a meta-analysis of published data regarding the performance of 18F-FACBC PET/CT in the diagnosis of recurrent prostate carcinoma.. A comprehensive review of the literature regarding the role of 18F-FACBC PET/CT in the diagnosis of recurrent prostate carcinoma was performed. Pooled sensitivity, specificity, and the area under the receiver-operating characteristic of 18F-FACBC PET/CT in the diagnosis of recurrent prostate carcinoma were calculated based on the included studies.. Six studies comprising 251 patients, suspicious of prostate carcinoma recurrence, were included in this meta-analysis. 18F-FACBC PET/CT had an 87% pooled sensitivity, 66% pooled specificity, 0.93 the area under the receiver-operating characteristic curve on a per patient-based analysis in detecting prostate carcinoma recurrence.. 18F-FACBC PET/CT was a non-invasive, metabolic imaging technique in the diagnosis of prostate carcinoma relapse.

Topics: Carboxylic Acids; Cyclobutanes; Humans; Male; Multimodal Imaging; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostate; Prostatic Neoplasms; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed

Radiolabelled choline positron emission tomography has changed the management of prostate cancer patients. However, new emerging radiopharmaceutical agents, like radiolabelled prostate specific membrane antigen, and new promising hybrid imaging will begin new challenges in the diagnostic field.. The continuous evolution in nuclear medicine has led to the improvement in the detection of recurrent prostate cancer (PCa), particularly distant metastases. New horizons have been opened for radiolabelled choline positron emission tomography (PET)/computed tomography (CT) as a guide for salvage therapy or for the assessment of systemic therapies. In addition, new tracers and imaging tools have been recently tested, providing important information for the management of PCa patients. Herein we discuss: (1) the available evidence in literature on radiolabelled choline PET and their recent indications, (2) the role of alternative radiopharmaceutical agents, and (3) the advantages of a recent hybrid imaging device (PET/magnetic resonance imaging) in PCa.. Data from recently published (2010-2015), original articles concerning the role of choline PET/CT, new emerging radiotracers, and a new imaging device are analysed. This review is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.. In the restaging phase, the detection rate of choline PET varies between 4% and 97%, mainly depending on the site of recurrence and prostate-specific antigen levels. Both 68gallium (68Ga)-prostate specific membrane antigen and 18F-fluciclovine are shown to be more accurate in the detection of recurrent disease as compared with radiolabelled choline PET/CT. Particularly, Ga68-PSMA has a detection rate of 50% and 68%, respectively for prostate-specific antigen levels < 0.5ng/ml and 0.5-2ng/ml. Moreover, 68Ga- PSMA PET/magnetic resonance imaging demonstrated a particularly higher accuracy in detecting PCa than PET/CT. New tracers, such as radiolabelled bombesin or urokinase-type plasminogen activator receptor, are promising, but few data in clinical practice are available today.. Some limitations emerge from the published papers, both for radiolabelled choline PET/CT and also for new radiopharmaceutical agents. Efforts are still needed to enhance the impact of published data in the world of oncology, in particular when new radiopharmaceuticals are introduced into the clinical arena.. In the present review, the authors summarise the last evidences in clinical practice for the assessment of prostate cancer, by using nuclear medicine modalities, like positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging.

Topics: Antigens, Surface; Carbon Radioisotopes; Carboxylic Acids; Choline; Cyclobutanes; Gallium Radioisotopes; Glutamate Carboxypeptidase II; Humans; Magnetic Resonance Imaging; Male; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Radiotherapy Planning, Computer-Assisted; Salvage Therapy

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

The prospective, multicenter LOCATE (F Fluciclovine [FACBC] PET/CT in Patients with Rising PSA after Initial Prostate Cancer Treatment) trial assessed the impact of positron emission tomography/computerized tomography with F-fluciclovine on treatment plans in patients with biochemical recurrence of prostate cancer after primary therapy with curative intent.. Men who had undergone curative intent treatment of histologically confirmed prostate cancer but who were suspected to have recurrence based on rising prostate specific antigen levels were enrolled prospectively. Each man had negative or equivocal findings on standard of care imaging. F-fluciclovine positron emission tomography/computerized tomography was performed according to standardized protocols. Treating physicians completed a questionnaire regarding the patient treatment plan before and after scanning, recording changes to the treatment modality (eg salvage radiotherapy to systemic androgen deprivation therapy) as major and changes in a modality (eg modified radiotherapy fields) as other.. Between June 2016 and May 2017, 213 evaluable patients with a median age of 67 years and median prostate specific antigen 1.00 ng/ml were enrolled in study. F-fluciclovine avid lesions were detected in 122 of the 213 patients (57%). Overall 126 of the 213 patients (59%) had a change in management after the scan, which were major in 98 of 126 (78%) and in 88 (70%) were informed by positive positron emission tomography/computerized tomography findings. The most frequent major changes were from salvage or noncurative systemic therapy to watchful waiting (32 of 126 cases or 25%), from noncurative systemic therapy to salvage therapy (30 of 126 or 24%) and from salvage therapy to noncurative systemic therapy (11 of 126 or 9%).. F-fluciclovine positron emission tomography/computerized tomography detected 1 or more recurrence sites in the majority of men with biochemical recurrence, frequently resulting in major changes to management plans. Future studies will be planned to determine whether a management change leads to improved outcomes.

Topics: Aged; Aged, 80 and over; Carboxylic Acids; Clinical Decision-Making; Cyclobutanes; Humans; Kallikreins; Male; Middle Aged; Neoplasm Recurrence, Local; Patient Selection; Positron Emission Tomography Computed Tomography; Prospective Studies; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms; Radiopharmaceuticals

We assessed the feasibility and cancer detection rate of fluciclovine (. A total of 21 patients with a mean ± SD prostate specific antigen of 7.4 ± 6.8 ng/ml and biochemical failure after nonoperative prostate cancer treatment underwent fluciclovine (. Template biopsy was positive for malignancy in 6 of 21 patients (28.6%), including 10 of 124 regions and 11 of 246 cores, vs targeted biopsy in 10 of 21 (47.6%), including 17 of 50 regions and 40 of 125 cores. Five of 21 patients had positive findings on targeted biopsy only and 1 of 21 had positive findings on template biopsy only. An additional case was upgraded from Grade Group 2 to 3 on targeted biopsy. Extraprostatic disease was detected in 8 of 21 men (38.1%) with histological confirmation in all 3 who underwent lesion biopsy.. Fluciclovine positron emission tomography real-time ultrasound fusion guidance for biopsy is feasible in patients with biochemical failure after nonsurgical therapy for prostate cancer. It identifies more recurrent prostate cancer using fewer cores compared with template biopsy in the same patient. Further study is required to determine in what manner targeted biopsy may augment template biopsy of recurrent prostate cancer.

Topics: Aged; Aged, 80 and over; Carboxylic Acids; Cyclobutanes; Feasibility Studies; Humans; Image-Guided Biopsy; Male; Middle Aged; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prospective Studies; Prostatic Neoplasms; Treatment Outcome; Ultrasonography

This multicenter, phase II clinical trial evaluated the diagnostic performance of 18F-fluciclovine, a novel amino acid for positron-emission tomography (PET), for detection of small lymph node metastases with short-axis diameters of 5-10 mm in patients with prostate cancer.. Patients with prostate cancer were eligible after screening of laboratory tests and pelvic contrast-enhanced computed tomography (CT). Pelvic region 18F-fluciclovine PET/CT was then acquired within 28 days and dissection of regional lymph nodes was performed within 60 days of pelvic contrast-enhanced CT. Diagnostic performance of 18F-fluciclovine-PET/CT was evaluated by comparison with standard histopathology of lymph nodes.. In a total of 28 patients, 40 regional lymph nodes with short-axis diameters of 5-10 mm were eligible for efficacy evaluation; seven of these showed metastases confirmed by histopathology. The sensitivity of 18F-fluciclovine PET/CT was 57.1% (4/7). All four true positive lymph nodes detected by 18F-fluciclovine PET/CT had a metastatic lesion with a long-axis diameter of ≥7 mm and a high proportion of cancer volume (60-100%) according to pathology evaluation. The specificity, diagnostic accuracy, positive predictive value, and negative predictive value of 18F-fluciclovine PET/CT in lymph node-based analysis were 84.8% (28/33), 80.0% (32/40), 44.4% (4/9), and 90.3% (28/31), respectively. No clinically significant adverse events occurred.. 18F-fluciclovine PET/CT detected small lymph node metastases; however it also showed positive findings in benign lymph nodes. Refinement of the image assessment criteria may improve the diagnostic performance of 18F-fluciclovine PET/CT for small lymph node metastases in patients with prostate cancer.

Topics: Aged; Carboxylic Acids; Cyclobutanes; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Pelvis; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Sensitivity and Specificity

One of the major challenges for all imaging modalities is accurate detection of prostate cancer (PCa) recurrence. Beyond the established Ga-PSMA, a novel promising PET tracer in PCa imaging is F-fluciclovine. For evaluating the advantages and disadvantages and the comparability, we conducted a prospective head-to-head comparison on F-fluciclovine and Ga-PSMA-11 in patients with biochemical recurrence of PCa.. 58 patients with biochemical recurrence of PCa after definitive primary therapy were included. Both scans were performed within a time window of mean 9.4 days. All scans were visually analyzed independently on a patient-, region- and lesion-based analysis. All the examinations were performed in the same medical department using identical scanners at any time.. The overall detection rate for PCa recurrence was 79.3% in F-fluciclovine and 82.8% in Ga-PSMA-11 (P = 0.64). Local recurrence was detected in 37.9% on F-fluciclovine and in 27.6% on Ga-PSMA-11 (P = 0.03). Local pelvic lymph node recurrence was detected on F-fluciclovine versus Ga-PSMA-11 in 46.6% versus 50%, in extrapelvic lymph node metastases in 41.4% versus 51.7% and in bone metastases in 25.9% versus 36.2%. Lesion-based analysis showed identical findings in local pelvic lymph nodes in 39.7%, in extrapelvic lymph nodes in 22.4%, and in bone metastases in 13.8%.. The advantage of F-fluciclovine is detecting curable localized disease in close anatomical relation to the urinary bladder, whereas Ga-PSMA-11 fails because of accumulation of activity in the urinary bladder. F-fluciclovine is almost equivalent to Ga-PSMA-11 in detecting distant metastases of PCa recurrence.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Carboxylic Acids; Cyclobutanes; Edetic Acid; Gallium Isotopes; Gallium Radioisotopes; Humans; Lymphatic Metastasis; Male; Middle Aged; Oligopeptides; Positron Emission Tomography Computed Tomography; Prospective Studies; Prostatic Neoplasms; Recurrence

This was a prospective, single-centre, open-label, single-arm comparative study done at University of California Los Angeles (Los Angeles, CA, USA). Patients older than 18 years of age with prostate cancer biochemical recurrence after radical prostatectomy and PSA levels ranging from 0·2 to 2·0 ng/mL without any prior salvage therapy and with a Karnofsky performance status of at least 50 were eligible. Patients underwent. With higher detection rates, PSMA should be the PET tracer of choice when PET-CT imaging is considered for subsequent treatment management decisions in patients with prostate cancer and biochemical recurrence after radical prostatectomy and low PSA concentrations (≤2·0 ng/mL). Further research is needed to investigate whether higher detection rates translate into improved oncological outcomes.. None.

Topics: Aged; Carboxylic Acids; Contrast Media; Cyclobutanes; Edetic Acid; Gallium Isotopes; Gallium Radioisotopes; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Oligopeptides; Positron Emission Tomography Computed Tomography; Prospective Studies; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms

We explored the influence of FACBC (fluciclovine) PET/CT on the decision to offer radiotherapy and radiotherapy treatment field recommendations in postprostatectomy patients with recurrent prostate cancer.. After obtaining institutional review board approval and informed consent, 87 patients with detectable prostate-specific antigen (PSA) levels were recruited into a prospective clinical trial. After an initial provider-determined radiotherapy plan based on conventional imaging, 44 of 87 patients were randomized to additionally undergo fluciclovine PET/CT. Pre- and post-fluciclovine radiotherapy decisions were compared and changes were noted. Statistical significance of these decision changes was determined.. Two of 44 patients in the experimental arm dropped out before fluciclovine scanning. Thirty-four (81.0%) of 42 had positive results on fluciclovine. Overall radiotherapy decision was changed in 17 (40.5%) of 42. Mean PSA, original Gleason score, and prostatectomy-PET interval did not differ significantly between patients with and without radiotherapy decision changes. Two (4.8%) of 42 had the decision for radiotherapy withdrawn due to positive extrapelvic findings. Radiotherapy field decision was changed in 15 (35.7%) of 42. Eleven (73.3%) of 15 had fields changed from prostate bed only to both prostate bed and pelvis, while 4 (26.7%) of 15 had fields changed from both prostate bed and pelvis to prostate bed only. Changes in overall radiotherapy decision and field were statistically significant (P < 0.0001). However, the change in the decision to offer radiotherapy or not was not statistically significant (P = 0.15).. Fluciclovine PET/CT significantly changed radiotherapy management decisions in postprostatectomy patients with recurrent prostate cancer. Further work in determining differences in PSA-free survival is ongoing.

Topics: Adult; Aged; Aged, 80 and over; Carboxylic Acids; Chronic Disease; Clinical Decision-Making; Cyclobutanes; Disease Management; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prospective Studies; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radiopharmaceuticals; Radiotherapy; Salvage Therapy

We performed a multicenter Phase IIb clinical trial of NMK36, a novel amino acid analog for positron emission tomography containing trans-1-amino-3-[(18)F]fluorocyclobutanecarboxylic acid, to evaluate its safety and diagnostic performance for primary prostate cancer.. Sixty-eight subjects with primary prostate cancer scheduled for radical prostatectomy or hormone therapy underwent whole-body positron emission tomography/computed tomography after injection of NMK36. The diagnostic performances of NMK36-positron emission tomography/computed tomography were evaluated for (i) regional lymph node metastasis: comparison with contrast-enhanced computed tomography under setting reference standard (histopathology or 6-month follow-up), (ii) bone metastasis: concordance rate with conventional imaging (combination of bone scintigraphy and contrast-enhanced computed tomography) and (iii) primary lesion: comparison with histopathological findings.. The accuracy of NMK36-positron emission tomography/computed tomography and contrast-enhanced computed tomography for regional lymph node metastasis were 85.5 and 87.3%, respectively. NMK36-positron emission tomography/computed tomography showed positive findings for regional lymph nodes with short-axis diameters of 5-9 mm at 23 regions in 13 patients of hormone therapy cohort, but they were not confirmed with reference standard in this study. The concordance rate of NMK36-positron emission tomography/computed tomography with conventional imaging for bone metastases was 83.3%, and seven patients had positive findings only by NMK36-positron emission tomography/computed tomography. The sensitivity and specificity of NMK36-positron emission tomography/computed tomography for primary lesion in six-segment analysis was 92.5 and 90.1%, respectively. Seven of non-serious adverse events were observed in six patients.. This study showed the comparable diagnostic performance of NMK36-positron emission tomography/computed tomography compared with conventional imaging. Some lesions of lymph node and bone were positive solely by NMK36-positron emission tomography/computed tomography, which needs to be confirmed with reference standard in future study to evaluate the usefulness of NMK36-positron emission tomography/computed tomography in staging prostate cancer.

Topics: Aged; Amino Acids; Antineoplastic Agents, Hormonal; Biomarkers, Tumor; Bone Neoplasms; Carboxylic Acids; Contrast Media; Cyclobutanes; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Positron-Emission Tomography; Predictive Value of Tests; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radiopharmaceuticals; Safety; Sensitivity and Specificity; Tomography, X-Ray Computed

To compare the accuracy of (18)F-FACBC and (11)C-choline PET/CT in patients radically treated for prostate cancer presenting with biochemical relapse.. This prospective study enrolled 100 consecutive patients radically treated for prostate cancer and presenting with rising PSA. Of these 100 patients, 89 were included in the analysis. All had biochemical relapse after radical prostatectomy (at least 3 months previously), had (11)C-choline and (18)F-FACBC PET/CT performed within 1 week and were off hormonal therapy at the time of the scans. The two tracers were compared directly in terms of overall positivity/negativity on both a per-patient basis and a per-site basis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated for both the tracers; follow-up at 1 year (including correlative imaging, PSA trend and pathology when available) was considered as the standard of reference.. In 51 patients the results were negative and in 25 patients positive with both the tracers, in eight patients the results were positive with (18)F-FACBC but negative with (11)C-choline, and in five patients the results were positive with (11)C-choline but negative with (18)F-FACBC. Overall in 49 patients the results were false-negative (FN), in two true-negative, in 24 true-positive (TP) and in none false-positive (FP) with both tracers. In terms of discordances between the tracers: (1) in one patient, the result was FN with (11)C-choline but FP with (18)F-FACBC (lymph node), (2) in seven, FN with (11)C-choline but TP with (18)F-FACBC (lymph node in five, bone in one, local relapse in one), (3) in one, FP with (11)C-choline (lymph node) but TP with (18)F-FACBC (local relapse), (4) in two, FP with (11)C-choline (lymph nodes in one, local relapse in one) but FN with (18)F-FACBC, and (5) in three, TP with (11)C-choline (lymph nodes in two, bone in one) but FN with (18)F-FACBC. With (11)C-choline and (18)F-FACBC, sensitivities were 32 % and 37 %, specificities 40 % and 67 %, accuracies 32 % and 38 %, PPVs 90 % and 97 %, and NPVs 3 % and 4 %, respectively. Categorizing patients by PSA level (<1 ng/ml 28 patients, 1 - <2 ng/ml 28 patients, 2 - <3 ng/ml 11 patients, ≥3 ng/ml 22 patients), the number (percent) of patients with TP findings were generally higher with (18)F-FACBC than with (11)C-choline: six patients (21 %) and four patients (14 %), eight patients (29 %) and eight patients (29 %), five patients (45 %) and four patients (36 %), and 13 patients (59 %) and 11 patients (50 %), respectively.. (18)F-FACBC can be considered an alternative tracer superior to (11)C-choline in the setting of patients with biochemical relapse after radical prostatectomy.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Carbon Radioisotopes; Carboxylic Acids; Choline; Cyclobutanes; False Negative Reactions; Humans; Lymphatic Metastasis; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prospective Studies; Prostate-Specific Antigen; Prostatic Neoplasms; Recurrence

(18)F-Fluciclovine (anti-1-amino-3-[(18)F]fluorocyclobutane-1-carboxylic acid) is a novel positron emission tomography (PET)/computed tomography (CT) radiotracer that has demonstrated utility for detection of prostate cancer. Our goal is to report the initial results from a randomized controlled trial of the integration of (18)F-fluciclovine PET-CT into treatment planning for defining prostate bed and lymph node target volumes.. We report our initial findings from a cohort of 41 patients, of the first enrolled on a randomized controlled trial, who were randomized to the (18)F-fluciclovine arm. All patients underwent (18)F-fluciclovine PET-CT for the detection of metabolic abnormalities and high-resolution CT for treatment planning. The 2 datasets were registered first by use of a rigid registration. If soft tissue displacement was observable, the rigid registration was improved with a deformable registration. Each (18)F-fluciclovine abnormality was segmented as a percentage of the maximum standard uptake value (SUV) within a small region of interest around the lesion. The percentage best describing the SUV falloff was integrated in planning by expanding standard target volumes with the PET abnormality.. In 21 of 55 abnormalities, a deformable registration was needed to map the (18)F-fluciclovine activity into the simulation CT. The most selected percentage was 50% of maximum SUV, although values ranging from 15% to 70% were used for specific patients, illustrating the need for a per-patient selection of a threshold SUV value. The inclusion of (18)F-fluciclovine changed the planning volumes for 46 abnormalities (83%) of the total 55, with 28 (51%) located in the lymph nodes, 11 (20%) in the prostate bed, 10 (18%) in the prostate, and 6 (11%) in the seminal vesicles. Only 9 PET abnormalities were fully contained in the standard target volumes based on the CT-based segmentations and did not necessitate expansion.. The use of (18)F-fluciclovine in postprostatectomy radiation therapy planning was feasible and led to augmentation of the target volumes in the majority (30 of 41) of the patients studied.

Topics: Carboxylic Acids; Cyclobutanes; Humans; Male; Middle Aged; Pilot Projects; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Image-Guided; Reproducibility of Results; Sensitivity and Specificity; Treatment Outcome; Workflow

We prospectively evaluated the amino acid analogue positron emission tomography radiotracer anti-3-[(18)F]FACBC compared to ProstaScint® ((111)In-capromab pendetide) single photon emission computerized tomography-computerized tomography to detect recurrent prostate carcinoma.. A total of 93 patients met study inclusion criteria who underwent anti-3-[(18)F]FACBC positron emission tomography-computerized tomography plus (111)In-capromab pendetide single photon emission computerized tomography-computerized tomography for suspected recurrent prostate carcinoma within 90 days. Reference standards were applied by a multidisciplinary board. We calculated diagnostic performance for detecting disease.. In the 91 of 93 patients with sufficient data for a consensus on the presence or absence of prostate/bed disease anti-3-[(18)F]FACBC had 90.2% sensitivity, 40.0% specificity, 73.6% accuracy, 75.3% positive predictive value and 66.7% negative predictive value compared to (111)In-capromab pendetide with 67.2%, 56.7%, 63.7%, 75.9% and 45.9%, respectively. In the 70 of 93 patients with a consensus on the presence or absence of extraprostatic disease anti-3-[(18)F]FACBC had 55.0% sensitivity, 96.7% specificity, 72.9% accuracy, 95.7% positive predictive value and 61.7% negative predictive value compared to (111)In-capromab pendetide with 10.0%, 86.7%, 42.9%, 50.0% and 41.9%, respectively. Of 77 index lesions used to prove positivity histological proof was obtained in 74 (96.1%). Anti-3-[(18)F]FACBC identified 14 more positive prostate bed recurrences (55 vs 41) and 18 more patients with extraprostatic involvement (22 vs 4). Anti-3-[(18)F]FACBC positron emission tomography-computerized tomography correctly up-staged 18 of 70 cases (25.7%) in which there was a consensus on the presence or absence of extraprostatic involvement.. Better diagnostic performance was noted for anti-3-[(18)F]FACBC positron emission tomography-computerized tomography than for (111)In-capromab pendetide single photon emission computerized tomography-computerized tomography for prostate carcinoma recurrence. The former method detected significantly more prostatic and extraprostatic disease.

Topics: Aged; Aged, 80 and over; Antibodies, Monoclonal; Carboxylic Acids; Carcinoma; Cyclobutanes; Humans; Indium Radioisotopes; Male; Middle Aged; Multimodal Imaging; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prospective Studies; Prostatic Neoplasms; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

[(18)F]Fluciclovine (anti-[(18)F]FACBC) is a synthetic amino acid developed for PET assessment of the anabolic component of tumour metabolism in clinical routine. This phase 1 trial evaluated the safety, tracer stability and uptake kinetics of [(18)F]fluciclovine in patients.. Six patients with biopsy-proven prostate cancer were investigated with 3-T MRI and PET/CT. All underwent dynamic [(18)F]fluciclovine PET/CT of the pelvic area for up to 120 min after injection of 418 ± 10 MBq of tracer with simultaneous blood sampling of radioactivity. The kinetics of uptake in tumours and normal tissues were evaluated using standardized uptake values (SUVs) and compartmental modelling.. Tumour deposits as defined by MRI were clearly visualized by PET. Urine excretion was minimal and normal tissue background was low. Uptake of [(18)F]fluciclovine in tumour from the blood was rapid and the tumour-to-normal tissue contrast was highest between 1 and 15 min after injection with a 65 % reduction in mean tumour uptake at 90 min after injection. A one-compartment model fitted the tracer kinetics well. Early SUVs correlated well with both the influx rate constant (K (1)) and the volume of distribution of the tracer (V (T)). There were no signs of tracer metabolite formation. The product was well tolerated in all patients without significant adverse events.. [(18)F]Fluciclovine shows high uptake in prostate cancer deposits and appears safe for use in humans. The production is robust and the formulation stable in vivo. An early imaging window seems to provide the best visual results. SUV measurements capture most of the kinetic information that can be obtained from more advanced models, potentially simplifying quantification in future studies.

Topics: Aged; Amino Acids; Biological Transport; Carboxylic Acids; Cyclobutanes; Feasibility Studies; Humans; Kinetics; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Radioactive Tracers; Safety; Tissue Distribution; Tomography, X-Ray Computed

A 58-year-old man with metastatic prostate cancer was treated with prostatectomy, radiation therapy to bone metastasis, and androgen deprivation therapy plus abiraterone. He had posttreatment nadir PSA of 0.1 ng/mL. A follow-up 18 F-fluciclovine PET performed with PSA of 0.3 ng/mL showed a focal tracer-avid lesion in the left prostatectomy bed. This lesion was negative on 18 F-DCFPyL PET/CT, but with typical MRI features for disease recurrence. Minimal urinary activity of fluciclovine helped detection of local disease recurrence in the prostatectomy bed.

Topics: Androgen Antagonists; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms

A 41-year-old woman with invasive lobular carcinoma of the breast underwent sequential 68Ga-PSMA-11 PET/CT and 18F-fluciclovine PET/CT as part of an ongoing clinical trial (NCT04750473). 68Ga-PSMA PET/CT showed increased radiotracer uptake in the uterine endometrium and left adnexa. 18F-fluciclovine PET/CT showed increased radiotracer uptake in a leiomyomatous uterus. A clinical 18F-FDG PET/CT demonstrated radiotracer uptake in the endometrium and a circumferential area of uptake in the left adnexa, a pattern more similar to the 68Ga-PSMA uptake pattern. This case highlights the discordance in the uptake pattern of 2 radiotracers approved for prostate cancer imaging but increasingly used in non-prostate malignancies imaging.

Topics: Adult; Fluorodeoxyglucose F18; Gallium Radioisotopes; Humans; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Uterus

We present different findings on 18 F-fluciclovine (Axumin) PET/CT and 18 F-NaF PET/CT images in a patient with prostate cancer metastasis. 18 F-Fluciclovine PET/CT scan showed intense uptake in left adrenal gland metastasis, only faint to mild uptake in multiple sclerotic osseous metastasis where 18 F-NaF bone PET/CT demonstrated intense uptake at these sites. Both examinations are needed to accurately evaluate visceral and osseous metastasis from prostate cancer.

Topics: Bone Neoplasms; Carboxylic Acids; Cyclobutanes; Female; Genital Neoplasms, Female; Humans; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

18 F-fluciclovine (Axumin; Blue Earth Diagnostics, Ltd, Oxford, United Kingdom) PET has shown value in detecting biochemical recurrent prostatic cancer. Lycopene, a plant-based carotenoid, is reported to have potential inhibitory effect on prostate cancer, as a complementary treatment. We report a case of biochemically recurrent prostate cancer showing treatment response to lycopene as seen on an 18 F-fluciclovine PET/CT correlating with serum prostate-specific antigen response.

Topics: Carboxylic Acids; Cyclobutanes; Humans; Lycopene; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

We aimed to evaluate the impact of 18 F-fluciclovine PET/CT imaging on failure-free survival (FFS) post-salvage radiotherapy (SRT) for prostate cancer (PCa) recurrence.. Seventy-nine patients were recruited in a phase 2/3 clinical trial to undergo 18 F-fluciclovine PET/CT before SRT for PCa. Four patients with extrapelvic disease were excluded. All patients were followed up at regular intervals up to 48 months. Treatment failure was defined as a serum prostate-specific antigen level of ≥0.2 ng/mL above the nadir after SRT, confirmed with an additional measurement, requiring systemic treatment or clinical progression. Failure-free survival was computed and compared between patients grouped according to 18 F-fluciclovine PET/CT imaging findings.. Eighty percent (60/75) of patients had a positive finding on 18 F-fluciclovine PET/CT, of which 56.7% (34/60) had prostate bed-only uptake, whereas 43.3% (26/60) had pelvic nodal ± bed uptake. Following SRT, disease failure was detected in 36% (27/75) of patients. There was a significant difference in FFS between patients who had a positive versus negative scan (62.3% vs 92.9% [ P < 0.001] at 36 months and 59.4% vs 92.9% [ P < 0.001] at 48 months). Similarly, there was a significant difference in FFS between patients with uptake in pelvic nodes ± bed versus prostate bed only at 36 months (49.8% vs 70.7%; P = 0.003) and at 48 months (49.8% vs 65.6%; P = 0.040). Failure-free survival was also significantly higher in patients with either negative PET/CT or prostate bed-only disease versus those with pelvic nodal ± prostate bed disease at 36 (78% vs 49.8%, P < 0.001) and 48 months (74.4% vs 49.8%, P < 0.001).. Findings on pre-SRT 18 F-fluciclovine PET/CT imaging, even when acted upon to optimize the treatment decisions and treatment planning, are predictive of post-SRT FFS in men who experience PCa recurrence after radical prostatectomy. A negative 18 F-fluciclovine PET/CT is most predictive of a lower risk of failure, whereas the presence of pelvic nodal recurrence portends a higher risk of SRT failure.

Topics: Carboxylic Acids; Humans; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Salvage Therapy; Treatment Failure

Molecular imaging better identifies anatomic regions of metastatic spread of prostate cancer compared with conventional imaging, resulting in para-aortic (PA) nodal metastases being increasingly identified. Consequently, some radiation oncologists electively treat the PA lymph node region in patients with gross or high risk of PA nodal involvement. The anatomic locations of at-risk PA lymph nodes for prostate cancer are unknown. Our objective was to use molecular imaging to develop guidelines for the optimal delineation of the PA clinical target volume (CTV) in patients with prostate cancer.. We used molecular PET/CT imaging to determine the anatomic locations of PA metastases to develop contouring guidelines for creating a prostate cancer PA CTV. Although the optimal patient selection and clinical benefits of PA radiation therapy remain uncertain, our results will aid in delineating the optimal target when PA radiation therapy is pursued.

Topics: Humans; Lymph Nodes; Lymphatic Metastasis; Male; Molecular Imaging; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Retrospective Studies

Biochemical recurrence of prostate cancer, detected by a rising PSA, may reflect intraprostatic or extraprostatic recurrence. 18F-Fluciclovine (Axumin), a synthetic amino acid substrate in tumor metabolism, has frequently been used for to localize recurrent prostate cancers. We present a 71-year-old man with biochemical recurrence of prostate cancer but no convincing imaging findings on 18F-fluciclovine PET/CT. Of note, however, was an incidental uptake within the anterior mediastinum, which was found on biopsy to be a type AB thymoma. With this, we stress that awareness of false-positive uptake patterns is crucial for accurate diagnosis of recurrent prostate cancer.

Topics: Aged; Carboxylic Acids; Cyclobutanes; Humans; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Thymoma; Thymus Neoplasms

We identified 21 patients with oligometastases upon first BCR (PSA 0.2-56.8 ng/mL) out of 89 eligible patients. There was a significant difference (p = 0.04) in the mean PSA levels between patients with local recurrence (n = 12) and those without local recurrence (n = 9). In the subgroup of analysis of patients without local recurrence, there was no significant association between mean PSA level and number of oligometastases (p = 0.83). Distribution of oligometastases included 66.7% isolated nodal disease and 33.3% bone only. Twelve (57.1%) patients had change in management to include change in ADT, salvage therapy, or both. Treatment change was initiated in 62.5%, 28.6%, 66.7%, 100%, and 100% of patients with 1, 2, 3, 4, and 5 oligometastatic lesions, respectively.

Topics: Humans; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Retrospective Studies

An 83-year-old man with castrate-resistant prostate cancer underwent an 18 F-fluciclovine PET/CT scan, which was negative for local disease recurrence or locoregional lymphadenopathy, but there were multiple fluciclovine-avid bone metastases. In addition, mildly avid bilateral adrenal nodules were thought to be benign. However, on follow-up PET/CT 10 months later, while on additional therapy with enzalutamide, the bilateral nodules became mass lesions with interval decreased fluciclovine avidity. Adrenal metastases were suspected given their rapid growth, with subsequent CT-guided biopsy revealing metastatic prostate cancer without tumor necrosis. This false-negative case highlights the diagnostic challenge of fluciclovine PET in characterizing adrenal lesions.

Topics: Aged, 80 and over; Carboxylic Acids; Cyclobutanes; Humans; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

This prospective study enrolled men with at least one PI-RADS 4/5 ROI on multi-parametric MRI and no csPCa on prior biopsy defined as Gleason grade group (GGG) > 1. All men underwent an Axumin PET/MRI and only-persistent PI-RADS > 2 ROI were advised to undergo a repeat biopsy. A PET cancer suspicion score (PETCSS) was internally developed to stratify PET avid lesions according to their suspicion of harboring csPCa. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of the PETCSS for predicting csPCa were assessed. Relative risk was calculated to analyze the association of baseline variables with csPCa on repeat biopsy.. Thirty-eight ROI on 36 enrolled men were analyzed. Fourteen (36.8%) were downgraded to PI-RADS 1/2 and were not subjected to repeat biopsy. Thirteen (92.9%) of these downgraded scans also exhibited low-risk PETCSS. Overall, 18/22 (81.2%) subjects underwent a repeat per protocol biopsy. Of the 20 ROI subjected to repeat biopsy, eight (40%) were found to harbour csPCa. The sensitivity, specificity, PPV and NPV of the PETCSS were 50, 50, 40, and 60%, respectively. No predictor of csPCa was found in the risk analysis.. Our pilot study showed that both MRI and PET sequences have limited performance for identifying those persistently suspicious PI-RADS 4/5 ROI that are found to harbor csPCa on repeat biopsy.

Topics: Biopsy; Humans; Image-Guided Biopsy; Magnetic Resonance Imaging; Male; Pilot Projects; Positron-Emission Tomography; Prospective Studies; Prostatic Neoplasms; Retrospective Studies

A 64-year-old man with a history of Gleason 7 (3 + 4) pT2cN0 prostatic adenocarcinoma status post prostatectomy underwent a fluciclovine PET/CT that showed a tracer-avid right upper lobe spiculated solitary pulmonary nodule. Follow-up FDG PET/CT showed a hypermetabolic right upper lobe spiculated solitary pulmonary nodule. Fine-needle aspiration was consistent with primary lung adenocarcinoma. Subsequently, right upper lobectomy was performed, and poorly differentiated lung adenocarcinoma was confirmed.

Topics: Adenocarcinoma of Lung; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Solitary Pulmonary Nodule

Topics: Humans; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms

18F-fluciclovine (fluciclovine) is an amino acid analog approved by the Food and Drug Administration for use as a radiotracer in positron emission tomography (PET) in men with biochemical recurrence of suspected prostate cancer. The purpose of this study was to investigate the initial institutional experience with 18F-fluciclovine in the evaluation of prostate cancer with biochemical recurrence.. This study was a retrospective review of 135 patients who underwent 18F-fluciclovine PET-computed tomography (PET-CT) at a single institution from August 2018 through January 2020. Prognostic information, including prostate-specific level antigen (PSA) at the time of diagnosis, initial risk, initial Gleason score, and initial stage, was reviewed as well as the PSA level at the time of the scan. The images were reviewed by two radiologists with fellowship training in nuclear medicine and additional training to interpret the fluciclovine studies. A minority of studies were reviewed by a third fellowship-trained radiologist under the guidance of the two nuclear medicine-trained radiologists. In cases with abnormal radiopharmaceutical uptake in lymph nodes, the short-axis dimension of the lymph node or largest lymph node with abnormal uptake was noted. If CT or bone scan was performed within 4 months of the 18F-fluciclovine PET-CT, findings on the alternate imaging were compared with the results of the 18F-fluciclovine PET-CT.. Our institutional positivity rate was 75.6%, with 64 (67.4%) patients with metastatic disease and 71 (52.6%) patients with local recurrence detected by fluciclovine. As expected, the rate of positive examinations increased with increasing PSA values measured at the time of imaging (. Our single-institution experience with 18F-fluciclovine PET-CT has the largest number of patients to date in the literature and demonstrates the ability of fluciclovine to help guide clinical management in the detection of early recurrent disease.

Topics: Aged; Carboxylic Acids; Cyclobutanes; Humans; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Recurrence; Retrospective Studies

18F-fluciclovine (Axumin) PET/CT has been widely used for the evaluation of biochemically recurrent prostate cancer following prior treatment. While lymph node and visceral organ metastases typically show increased radiotracer uptake, altered patterns of normal physiologic activity may also provide insight into other disease processes. We present a case of an incidental pancreatic head mass presenting as a photopenic defect on a staging 18F-fluciclovine PET/CT, which was subsequently confirmed to be a benign serous cystadenoma using multisequence MRI.

Topics: Carboxylic Acids; Cyclobutanes; Cystadenoma, Serous; Humans; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

A 60-year-old man with prostate adenocarcinoma status post radical prostatectomy and bilateral pelvic lymph node dissection referred for restaging F-fluciclovine PET/CT due to rising serum prostate-specific antigen levels (1.1 ng/mL at that time of imaging). PET/CT images were obtained from the proximal thighs to the vertex of the skull approximately 3 to 5 minutes after the IV administration of 347.8 MBq (9.4 mCi) of F-fluciclovine. PET/CT imaging demonstrated a focus of abnormally increased F-fluciclovine uptake at the right ureterovesical junction. Subsequent MRI of the pelvis revealed that this focus corresponded to a benign ureterocele.

Topics: Biological Transport; Carboxylic Acids; Cyclobutanes; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Prostatectomy; Prostatic Neoplasms; Ureterocele

Prostate cancer (PC) is one of the most common cancers affecting men worldwide, with a high recurrence rate after therapy. 68Ga-PSMA-11 and 18F-fluciclovine are PET imaging tracers for the detection of recurrence sites in PC patients. 68Ga-PSMA-11 is a membrane antigen overexpressed by tumor cells, whereas 18F-fluciclovine targets increased amino acid transporter in the membrane of cancer cells. We report a case of an 83-year-old man with known oligodendroglioma and biochemically recurrent PC who shows a high focal 68Ga-PSMA-11 and 18F-fluciclovine uptake in the brain.

Topics: Aged, 80 and over; Carboxylic Acids; Cyclobutanes; Edetic Acid; Gallium Isotopes; Gallium Radioisotopes; Humans; Male; Oligodendroglioma; Oligopeptides; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Recurrence

18F-Fluciclovine PET/CT has become a common diagnostic imaging study used in the evaluation of biochemical recurrence in prostate cancer since its approval in 2016. We present a case report of an 82-year-old man with history of both prostate and bladder cancer who presented for a fluciclovine study due to rising PSA levels. There was incidental detection of focal penile activity, and a subsequent urethral biopsy performed showed urothelial carcinoma, which was also seen on a subsequent MRI study.

Topics: Aged, 80 and over; Carboxylic Acids; Cyclobutanes; Humans; Incidental Findings; Magnetic Resonance Imaging; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Recurrence; Urologic Neoplasms

A 66-year-old man with prostate adenocarcinoma status post radical retropubic prostatectomy and bilateral pelvic lymph node dissection, followed by salvage external beam radiation therapy to the prostate bed 1 year after surgery. Over the course of 17 years, the patient underwent multiple lines of systemic treatment for recurrent disease. He was referred for restaging 18F-fluciclovine PET/CT due to rising serum prostate-specific antigen levels. Contrast-enhanced 18F-fluciclovine PET/CT images demonstrated multiple new liver metastases, which were relatively photopenic in comparison with the physiologic radiotracer activity in the surrounding normal liver parenchyma.

Topics: Aged; Carboxylic Acids; Cyclobutanes; Humans; Liver Neoplasms; Male; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Salvage Therapy

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

We present a case of metastatic gastrointestinal stromal tumor incidentally detected on 18F-fluciclovine PET/CT. A 68-year-old man with history of intermediate-risk prostate cancer (Gleason score 4 + 3 = 7; pT2cN0M0) previously treated with retropubic radical prostatectomy, adjuvant whole pelvis radiation, and androgen deprivation therapy (leuprolide) presented with slowly rising serum prostate-specific antigen over 3 years, concerning for recurrent prostate cancer. To identify potential sites of recurrent disease, an 18F-fluciclovine PET/CT was obtained. Multiple tracer-avid mesenteric masses and enlarged lymph nodes were found throughout the abdomen and pelvis, later biopsy-proven to reflect metastatic gastrointestinal stromal tumor.

Topics: Aged; Carboxylic Acids; Cyclobutanes; Gastrointestinal Stromal Tumors; Humans; Incidental Findings; Male; Neoplasm Grading; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

We carried out a retrospective cohort study of patients with BR after primary treatment of PC who received imaging with 18F-fluciclovine PET/CT at our institution between January 2010 and January 2019. PET/CT results were compared with biopsy, conventional imaging results, and/or response to PC therapy. 18F-Fluciclovine PET/CT performance statistics and effects on treatment planning were calculated.. A total of 328 patients with a median age of 71 years (range, 47-90 years) and median serum prostate-specific antigen level of 1.6 ng/mL (0.02-186.7 ng/mL) were included. Three hundred thirty-six 18F-fluciclovine PET/CT scans were analyzed and classified as positive (65%), negative (25%), or equivocal (10%) based on radiology reports. Sensitivity was 93% (95% confidence interval, 86%-96%) and specificity was 63% (95% confidence interval, 45%-77%). Of patients with known management recommendations post-PET/CT, scan results changed or influenced pre-PET/CT management plans in 73%, and 58% of recommendations involved treatment modality decisions. Overall, 82% of patients' actual management was concordant with post-PET/CT recommendations. Of evaluable patients, 116 (35%) had some form of post-PET radiotherapy included in their care plans, with 95% receiving radiotherapy at a PET-avid target.. In the largest single-institutional cohort to date, 18F-fluciclovine PET/CT showed value in the workup of PC in the setting of BR, with noteworthy influence over clinical management decisions. Further studies are needed to evaluate whether PET/CT-based changes in management are associated with improved outcomes.

Topics: Aged; Aged, 80 and over; Biopsy; Carboxylic Acids; Clinical Decision-Making; Cyclobutanes; Humans; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Retrospective Studies

A 74-year-old man with biochemical recurrent prostate cancer underwent 18F-fluciclovine PET/CT for restaging to determine subsequent treatment strategy. 18F-fluciclovine PET/CT imaging demonstrated incidental focal heterogeneous increased 18F-fluciclovine uptake corresponding to a soft tissue nodule within the musculature of the left anterior abdominal wall. Subsequent ultrasound-guided biopsy of the lesion revealed histopathology compatible with a desmoid tumor. Consequently, the patient underwent surgical resection with wide local excision of the lesion.

Topics: Aged; Biological Transport; Carboxylic Acids; Cyclobutanes; Fibromatosis, Aggressive; Humans; Incidental Findings; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

To determine preoperative diagnostic accuracy of 18F-fluciclovine PET/CT-scan in detection (or exclusion) of lymph node metastases (LNM) in men with prostate cancer (PCa) in comparison to the histopathological results of the extended pelvic lymph node dissection (e-PLND).. A retrospective medical records-based cohort study, including 47 men with primary PCa who received 18F-fluciclovine PET/CT and subsequent e-PLND for lymph node staging. Incidence and number of visualized LNM, their locations and diameters on 18F-fluciclovine PET/CT were recorded in comparison to the histopathological results of the e-PLND as reference. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and diagnostic accuracy of 18F-fluciclovine PET/CT were calculated on the basis of histopathology results after e-PLND.. Forty-seven men were eligible for analysis. Median lymph node yield was 19 (range 10-70). A total of 996 lymph nodes were removed, and 59 metastases were found in 21 cases (45%). Preoperative PET was issued 'positive' in 11 men and in 9 of them (82%) this was histopathologically confirmed resulting in a PPV of 82% (95% CI, 51-96). On the contrary, PET was issued 'negative' in 36 cases, but in 12 of them (33%) metastases were detected in the e-PLND specimen, resulting in an NPV of 67% (95% CI, 50-80). The patient-based sensitivity was 43% (95% CI, 24-64) and the patient-based specificity rate was 92% (95% CI, 75-99), whereas overall diagnostic accuracy was established to be 70% in the present cohort.. 18F-Fluciclovine PET/CT has a high specificity and positive predicted value for the presence of LNM in men with prostate cancer. However, the sensitivity and NPV seem to be limited to exclude the absence of LNM at a clinically acceptable level. Prospective evaluation is necessary to define patients who may benefit from 18F-fluciclovine PET/CT as a triage test for the indication for e-PLND.

Topics: Aged; Carboxylic Acids; Cyclobutanes; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Sensitivity and Specificity

To evaluate the characteristics of FACBC PET/CT in detecting recurrent prostate cancer after radiation or prostatectomy. The secondary aim was to determine the impact of FACBC PET/CT on radiation treatment recommendations in men with biochemical recurrence postprostatectomy.. This is a single center retrospective study of men who underwent an FACBC PET/CT for rising PSA after definitive prostate cancer therapy. Detection rates in men with recurrence following any definitive treatment were compared at different PSA levels and anatomical sites. Radiotherapy treatment recommendations for patients postprostatectomy based on conventional imaging findings were compared to recommendations based on FACBC PET/CT findings.. A total of 103 men underwent imaging with FACBC PET/CT. 74.8% (77) had lesions consistent with sites of prostate cancer recurrence. At PSA thresholds of <1, 1-2, and >2 ng/mL lesions were detected in 35.5%, 63.6%, and 95.2% of patients respectively (P <.001). The most common site of recurrence was outside of the pelvis (37). Detection of extraprostatic or extrapelvic recurrence was observed in 45.5% of men in the PSA tertile <1ng/mL. FACBC PET/CT results led to changes to the recommended radiotherapy treatment plan in 44.1% (15/34) of men with recurrence following radical prostatectomy.. FACBC PET/CT demonstrated increased detection of recurrent prostate cancer with increasing PSA levels. Most recurrences were found outside the pelvis. Results of FACBC PET/CT changed radiotherapy management decisions in men treated with prostatectomy, supporting its use in localizing sites of disease recurrence in men with prostate cancer.

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

To evaluate the rate of incidental detection of central nervous system (CNS) meningioma in patients undergoing 18F-fluciclovine PET/computed tomography (CT) imaging for the evaluation of prostate cancer.. The reports of 850 18F-fluciclovine PET/CT scans in 566 patients with pathologically proven prostate cancer performed from April 2017 to July 2019, were retrospectively reviewed for the presence of CNS meningioma.. A total of 14 patients (2.8%) (age range: 54-82 years old) had abnormal focal intracranial 18F-fluciclovine uptake, all extra-axial in location (SUVmax range: 3.2-19.3). Two cases out of 14 (0.35%) were diagnosed as metastatic lesions. Twelve out of the 14 patients, had 18F-fluciclovine PET/CT imaging findings suspicious for CNS meningioma, 2 of them received another diagnosis on further imaging, and only 10 cases (2%) had the diagnosis of meningioma according to follow-up MRI and 18F-fluciclovine PET/CT.. Focal 18F-fluciclovine avid intracranial lesions incidentally detected in patients undergoing PET/CT imaging for prostate cancer are most often CNS meningiomas.

Topics: Aged; Aged, 80 and over; Carboxylic Acids; Cyclobutanes; Humans; Male; Meningioma; Middle Aged; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Retrospective Studies

18F-fluciclovine is a radiolabeled synthetic amino acid recently approved by the Food and Drug Administration for evaluating recurrent prostate cancer. Upregulated amino acid transporters in prostate cancer cells result in elevated radiotracer uptake in sites of tumor recurrence. However, 18F-fluciclovine is not specific for prostate cancer. Nonprostatic malignancies and benign conditions can also demonstrate uptake. This information combined with the knowledge about common patterns of prostate cancer recurrence helps guide appropriate management. We present an 87-year-old man with biochemical recurrence for prostate cancer but found to have a urinary bladder wall mass on 18F-fluciclovine PET/CT with moderate avidity. Biopsy revealed papillary urothelial carcinoma.

Topics: Aged, 80 and over; Carboxylic Acids; Carcinoma, Papillary; Cyclobutanes; Humans; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Urinary Bladder Neoplasms

A 69-year-old man presented with lower urinary tract symptoms and prostate biopsy showed prostate cancer. F-Fluciclovine PET/CT revealed abnormal increased radiotracer uptake within the prostate gland, and multiple osseous structures, suspicious for tumoral involvement. Incidentally, an expansile soft tissue density mass arising from sella turcica demonstrated increased radiotracer activity. MRI showed a lobulated enhancing mass centered in the sella and eroding into the sphenoid sinus. The differential diagnosis includes pituitary macroadenoma versus prostate cancer metastasis. The tumor was resected and the pathological diagnosis was pituitary adenoma.

Topics: Adenoma; Aged; Carboxylic Acids; Cyclobutanes; Humans; Magnetic Resonance Imaging; Male; Pituitary Neoplasms; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

A 72-year-old man with a history of T1cN0M0 prostate adenocarcinoma and rising prostate-specific antigen underwent a fluciclovine PET/CT scan that showed high uptake in several para-aortic nodes, suspicious for prostate cancer. A right upper lobe single pulmonary nodule (SPN), demonstrated only mild uptake, which raised the suspicion for a lung primary. Subsequent FDG PET/CT showed high uptake in the SPN, revealing poorly differentiated adenocarcinoma at biopsy, but with no abnormal uptake in the para-aortic nodes. This case highlights the complementary potential of fluciclovine and FDG PET in patients with a history of prostate cancer biochemical recurrence and SPN.

Topics: Adenocarcinoma of Lung; Aged; Biological Transport; Carboxylic Acids; Cyclobutanes; Fluorodeoxyglucose F18; Humans; Male; Neoplasms, Multiple Primary; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Recurrence

Topics: Carboxylic Acids; Cyclobutanes; Gallium Isotopes; Gallium Radioisotopes; Humans; Male; Membrane Glycoproteins; Organometallic Compounds; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals

Fat-containing mediastinal masses, particularly mediastinal liposarcomas, are rare neoplasms that can grow to large sizes before becoming symptomatic and may be incidentally found on radiology examinations. In this case report, a 67-year-old male with a history of prostate cancer status post prostatectomy presented for an F-18-fluciclovine PET/CT for a rising, clinically detectable PSA and indeterminate pelvic lymph nodes seen on multiparametric MRI of the prostate. No local tumor recurrence or metastatic disease from prostate cancer was identified, but the PET/CT demonstrated a mixed soft tissue and fat density prevascular (anterior) mediastinal mass with low-level radiotracer uptake. Following surgical consultation and resection, the final pathology revealed a dedifferentiated mediastinal liposarcoma. The case presented describes the appearance of an uncommon fat-containing mediastinal mass and describes several other fat-containing mediastinal masses that are important for radiologists to recognize in order to formulate accurate differential diagnoses and ensure appropriate further management for patients. Additionally, this case demonstrates that the radiotracer F-18-fluciclovine is not specific for prostate cancer, and its uptake can be seen with other entities such as in this case of sarcomatous malignancy.

Topics: Aged; Carboxylic Acids; Cyclobutanes; Humans; Liposarcoma; Lymph Nodes; Male; Mediastinum; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostatectomy; Prostatic Neoplasms; Radiopharmaceuticals

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 67-year-old asymptomatic man with biochemical recurrent prostate cancer underwent F-fluciclovine PET/CT for restaging to determine subsequent treatment strategy. PET/CT images were obtained from the proximal thighs to the vertex of the skull, after the intravenous administration of 362.6 MBq (9.8 mCi) of F-fluciclovine. PET/CT imaging demonstrated a focus of abnormally increased F-fluciclovine uptake corresponding to a small nodularity in the left parotid gland. Subsequent ultrasound-guided fine-needle aspiration biopsy of the lesion revealed histopathology compatible with a benign Warthin tumor.

Topics: Adenolymphoma; Aged; Carboxylic Acids; Cyclobutanes; Humans; Incidental Findings; Male; Parotid Neoplasms; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals

The aim of this study was to investigate the imaging diagnostic performance of F-fluciclovine PET/CT and pelvic multiparametric MRI (mpMRI) for prostate cancer in the setting of rising PSA after initial treatment, with a focus on detection of recurrent and metastatic prostate cancer in the pelvis.. Patients with prostate cancer who had fluciclovine PET and pelvic mpMRI between October 2017 and October 2018 in our center were retrospectively reviewed. Patients were included if they had fluciclovine PET/CT and mpMRI within a 3-month interval. Patients were excluded if they had separate concurrent cancer or if the PSA were more than 2-fold difference with an absolute difference more than 1 ng/mL between the 2 image studies. For each eligible patient, we compared all abnormal lesions identified on either scan. The findings were verified by pathology or other imaging techniques within minimal 10-month clinical follow-up.. A total of 129 patients with 129 paired tests were included in this study. Fluciclovine PET/CT and pelvic MRI had a high degree of concordance (121/129, 93.8%). The sensitivity, specificity, positive predictive value, and negative predictive value for fluciclovine PET/CT and mpMRI were 96.6%, 94.3%, 93.4%, and 97%, and 91.5%, 95.7%, 94.7%, and 93%, respectively. There were no statistical significant differences in diagnostic performance between the 2 imaging tests. Among the 8/129 discordant cases, although fluciclovine PET/CT provided definitive diagnosis when mpMRI was equivocal due to paramagnetic artifacts from fiducial markers and detected normal-sized regional lymph nodes, mpMRI detected subcentimeter periurethral recurrence and clarified physiological urinary artifacts that was not appreciated on fluciclovine PET/CT.. Our single-center study demonstrated that fluciclovine PET/CT has similar diagnostic performance with pelvic mpMRI in detecting recurrent/metastatic prostate disease in the pelvis in the setting of rising PSA after initial treatment. Moreover, fluciclovine PET/CT and mpMRI have different implications in different clinical scenario; each test has its own limitation and pitfalls, but can be complementary to each other.

Topics: Aged; Carboxylic Acids; Cyclobutanes; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvis; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Radiopharmaceuticals

An 85-year-old asymptomatic man with suspected biochemical recurrence of prostate cancer underwent an F-fluciclovine PET/CT scan, which revealed a solitary suspicious tracer uptake in the dorsal right corporal body of the proximal pendulous penis. The patient underwent ultrasound-guided fine-needle aspiration of the penile lesion, which revealed metastatic prostate cancer. The patient had definitive external beam radiation therapy 3 years before the examination. At the time of scan, the prostatic-specific antigen (PSA) was only 1.0 ng/mL, although the PSA doubling time was 2.6 months. It is unusual to detect a solitary penile metastasis in a patient with a low level of PSA.

Topics: Aged, 80 and over; Carboxylic Acids; Cyclobutanes; Humans; Male; Penile Neoplasms; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms

To evaluate various Prostate-Specific Antigen (PSA) thresholds at which a. We analyzed available records of men who underwent a. This study constitutes an early single institution series evaluating the use of

Topics: Carboxylic Acids; Cyclobutanes; Humans; Male; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Retrospective Studies

Late recurrence of prostate cancer after remission with prior radical prostatectomy is uncommon. This is a unique case of biochemical recurrence after being in remission for 12 years. The patient presented with swelling of the right lower extremity with pelvic MRI demonstrating an arterially enhancing filling defect in the right common iliac. An F-fluciclovine PET/CT showed corresponding increased intravascular radiotracer activity. Targeted biopsy of the intravascular lesion showed poorly differentiated carcinoma, suggestive of prostate origin. Although MRI evaluation is the mainstay for pelvic evaluation, characterization with F-fluciclovine PET/CT imaging adds high whole-body specificity and diagnostic accuracy.

Topics: Aged; Biopsy; Blood Vessels; Carboxylic Acids; Cyclobutanes; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostatectomy; Prostatic Neoplasms; Sensitivity and Specificity

F-Fluciclovine is the most recent prostate cancer (PCa)-directed PET radiotracer approved by the US Food and Drug Administration for detection of recurrent PCa. We report the treatments and outcomes of patients at our institution with PCa recurrences detected on F-fluciclovine PET/CT.. We identified men with recurrent PCa detected on F-fluciclovine PET/CT performed between 2017 and 2018 who were previously treated definitively and analyzed their patterns of care and cancer-specific outcomes.. We identified 28 men with recurrent PCa detected on F-fluciclovine PET/CT. Twenty-three were initially treated with surgery and 13 also received postoperative radiation therapy (RT). Five patients were initially treated with definitive radiation. After surgery, the median time to F-fluciclovine PET/CT was 67 months (median prostate-specific antigen [PSA] of 1.63 ng/mL). After RT, the median time to F-fluciclovine PET/CT was 95 months with median PSA of 13.31 ng/mL. Six men recurred locally, 9 recurred in the pelvic nodes, 9 had distant nodal recurrences, and 4 had osseous metastases. Of the patients initially treated with surgery, 4 received salvage radiation and 3 received androgen deprivation therapy (ADT). Of the patients initially treated with surgery and postoperative RT, 3 received salvage pelvic nodal dissection, 4 received salvage radiation, and 2 received ADT. Of the patients initially treated with radiation, 4 received salvage ADT. All had PSA decline after salvage therapy.. F-fluciclovine PET/CT can localize PCa recurrences, and subsequent salvage therapies appear effective with decreasing PSA. Longer follow-up will reveal if these diagnostic tests and subsequent therapies will improve PCa survival.

Topics: Aged; Androgen Antagonists; Bone Neoplasms; Carboxylic Acids; Cyclobutanes; Humans; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Recurrence; Salvage Therapy

Uncommon penile metastasis from prostate cancer has been reported on PET/CT imaging with F-FDG, F-fluorocholine, C-choline, and Ga-PSMA. The author presents an additional case of F-fluciclovine PET/CT depiction of proximal and distal cavernosal metastases from prostate cancer with corresponding contrast-enhanced CT findings.

Topics: Carboxylic Acids; Cyclobutanes; Humans; Male; Penile Neoplasms; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

A total of 251 consecutive. For the 2D-CNN slice-based approach, 6800 and 536 slices were used for training and test datasets, respectively. The sensitivity and specificity of this model were 90.7% and 95.1%, and the area under the curve (AUC) of receiver operating characteristic curve was 0.971 (p < 0.001). For the case-based approaches using both 2D-CNN and 3D-CNN architectures, a training dataset of 100 images and a test dataset of 28 images were randomly allocated. The sensitivity, specificity, and AUC to discriminate abnormal images by the 2D-CNN and 3D-CNN case-based approaches were 85.7%, 71.4%, and 0.750 (p = 0.013) and 71.4%, 71.4%, and 0.699 (p = 0.053), respectively.. DL accurately classifies abnormal

Topics: Carboxylic Acids; Cyclobutanes; Deep Learning; Humans; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostatic Neoplasms; Tomography, X-Ray Computed

The aim of this study was to investigate the role of F-fluciclovine PET/CT in the evaluation of prostate cancer (PC) patients after definitive treatment in the presence of undetectable prostate-specific antigen (PSA).. This retrospective study was conducted in PC patients who had undetectable PSA level and underwent fluciclovine PET/CT within a 2-week interval of PSA examination and without interval treatment or other cancer. Patient and tumor characteristics at initial diagnosis, treatment regimens, and findings on fluciclovine PET/CT were collected. Comparisons between groups of positive and negative fluciclovine PET/CT were done by using descriptive statistics.. A total of 34 fluciclovine PET/CTs from 34 patients met the inclusion criteria. There were 4 positive (11.8%) and 30 negative fluciclovine PET/CTs (88.2%). All of the patients with positive results had an initial Gleason score of 7 or higher and locally advanced tumor (T3-T4). More common features at the time of diagnosis among positive study patients as compared with negative ones were atypical histologic variants (25% vs 0%) and very high-risk PC (50% vs 30%). Most of the patients with positive study received second-line hormonal therapy (HT) (50%), whereas patients with negative results received first-line HT (53.3%). Chemotherapy naivety was less common among positive patients (75% vs 96.7%). Sites of involvement on positive fluciclovine PET/CTs were pelvic lymph nodes (2/4, 50%), lung and mediastinal lymph node (1/4, 25%), and prostatectomy bed (1/4, 25%).. In the presence of undetectable PSA in PC patients after definitive treatment, fluciclovine PET/CT would benefit most to patients with Gleason score of 7 or higher, high disease burden (T3-T4), and atypical histologic variants at the time of diagnosis, and the ones who have history of second-line HT and/or chemotherapy.

Topics: Aged; Carboxylic Acids; Cyclobutanes; Humans; Limit of Detection; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Grading; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Retrospective Studies

F-fluciclovine is a PET radiotracer approved for detection of recurrent prostate cancer, with utility in other malignancies being investigated. We present the case of a 71-year-old man with high-risk primary prostate cancer (Gleason score 9, prostate-specific antigen 34 ng/mL) and newly diagnosed lung adenocarcinoma. As part of a clinical trial (NCT03081884), preoperative F-fluciclovine PET/CT showed localized abnormal uptake in the prostate gland with extracapsular extension. Additionally, an incidental anterior mediastinal mass measuring 2.2 × 1.8 cm demonstrated abnormal radiotracer uptake. Biopsy of the mediastinal mass confirmed invasive lung adenocarcinoma with solid and acinar patterns and high programmed death 1 ligand expression.

Topics: Adenocarcinoma of Lung; Aged; Biopsy; Carboxylic Acids; Cyclobutanes; Humans; Incidental Findings; Male; Mediastinum; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

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

Topics: Carboxylic Acids; Cyclobutanes; Humans; Image Processing, Computer-Assisted; Male; Positron Emission Tomography Computed Tomography; 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

Topics: Aged; Brachytherapy; Carboxylic Acids; Cyclobutanes; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prospective Studies; Prostate; Prostatic Neoplasms; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity

As F-fluciclovine (FACBC) becomes more popular, new incidental findings are discovered. We present here a case of a 71-year-old man with prostate cancer in whom an FACBC PET/CT showed uptake in the superior sagittal sinus, which was found to be simply due to a dilated superior sagittal sinus on subsequent MRI. Accumulation in the superior sagittal sinus is a variant that interpreters of FACBC PET/CT should be aware of.

Topics: Aged; Carboxylic Acids; Cyclobutanes; Humans; Incidental Findings; Magnetic Resonance Imaging; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Superior Sagittal Sinus

Topics: Academic Medical Centers; Aged; Aged, 80 and over; Carboxylic Acids; Cyclobutanes; Demography; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Referral and Consultation

Topics: Aged; Carboxylic Acids; Carcinoma, Squamous Cell; Cyclobutanes; Humans; Male; Neoplasm Recurrence, Local; Penile Neoplasms; Positron Emission Tomography Computed Tomography; Prognosis; Prostatic Neoplasms

The aims of this study were to report on our initial experience using F-fluciclovine PET/CT to detect recurrent prostate carcinoma in patients with low serum prostate-specific antigen (PSA) after definitive treatment of primary disease and to conduct a preliminary investigation for factors associated with positive scan findings.. In this retrospective study, F-fluciclovine PET/CT scans from 28 men with suspected recurrence of prostate carcinoma and PSA values of 1 ng/mL or less were examined to identify the site(s) of disease recurrence. Differences in detection rate for Gleason scores of 7 and greater than 7, T2 and T3 disease, negative and positive surgical margins, and negative and positive seminal vesicle invasion were compared using the Fisher exact test. Mean PSA and mean PSA doubling time of patients with positive scans and negative scans were compared using the independent 2-group t test.. At least one site of disease recurrence was identified in 13 (46.4%) of 28 patients. Disease detection rate was significantly higher in patients with history of Gleason score greater than 7 (Fisher exact test, P = 0.004). Mean PSA and PSA doubling time were not significantly different between patients with positive and negative F-fluciclovine PET/CT scans (P = 0.29 and 0.70, respectively).. Detection of recurrent prostate cancer using F-fluciclovine PET/CT is possible in patients with low but rising PSA levels of 1 ng/mL or less. In such patients, local and nodal recurrences are more common than distant metastasis, and Gleason score greater than 7 is associated with positive scan results.

Topics: Aged; Carboxylic Acids; Cyclobutanes; Humans; Male; Middle Aged; Neoplasm Grading; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Recurrence; Retrospective Studies

A 76-year-old man presented with recently diagnosed prostate adenocarcinoma, Gleason score of 4 + 4, and a Super bone scan with concurrent PSA of 1.7 ng/mL. Approximately 3.5 months later, an F-fluciclovine PET/CT was performed despite of a decreased PSA of 0.3 ng/mL. A Superscan fluciclovine PET/CT was identified, and bone metastasis were later confirmed at biopsy.

Topics: Aged; Biopsy; Bone Neoplasms; Carboxylic Acids; Cyclobutanes; Humans; Male; Neoplasm Grading; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms

A 78-year-old man with biochemically recurrent prostate adenocarcinoma (prostate-specific antigen, 2.3 ng/mL) but without detectable disease in the chest, abdomen, or pelvis at conventional CT imaging or in the bones at Tc-MDP scintigraphy underwent F-fluciclovine (anti-1-amino-3-F-fluorocyclobutane-1-carboxylic acid) PET/CT to evaluate for occult recurrent or metastatic disease. Imaging identified intense radiotracer uptake within 3 dural-based lesions along the left cerebral convexity. Subsequent MRI and biopsy confirmed multifocal World Health Organization grade 2 atypical meningiomas. Focal intracranial radiotracer uptake at F-fluciclovine PET/CT may create a diagnostic dilemma as incidental meningiomas can mimic intracranial metastases.

Topics: Aged; Brain Neoplasms; Carboxylic Acids; Cyclobutanes; Diagnosis, Differential; Humans; Male; Meningeal Neoplasms; Meningioma; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals

The purpose of these guidelines is to assist specialists in Nuclear Medicine and Radionuclide Radiology in recommending, performing, interpreting and reporting F-fluciclovine PET/computed tomography. It should be recognised that adherence to the guidance in this document will not assure an accurate diagnosis or a successful outcome. These guidelines will assist individual departments in the formulation of their own local protocols. The guidelines apply to studies on adults. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources and the needs of the patient in order to deliver effective and safe medical care.

Topics: Carboxylic Acids; Cyclobutanes; Humans; Image Processing, Computer-Assisted; Injections; Male; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Practice Guidelines as Topic; Prostatic Neoplasms; Radiation Exposure; United Kingdom

Since its recent approval by the United States Food and Drug Administration, fluciclovine PET-CT has gained widespread use for imaging of recurrent prostate cancer patients. As an amino acid-based radiotracer transported by LAT-1 and ASCT-2 transporters, fluciclovine exploits the up-regulation of amino acid transporters in malignant cells. We present a rare case of fluciclovine uptake in Paget disease in a 58-year-old man with suspected recurrent prostate cancer and asymmetric increased left hemipelvic uptake on imaging.

Topics: Biological Transport; Carboxylic Acids; Cyclobutanes; Humans; Male; Middle Aged; Osteitis Deformans; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Recurrence

We present 4 cases of patients who underwent F-fluciclovine PET for prostate cancer demonstrating physiologic uptake in the celiac ganglia, which could be mistaken for metastatic lymphadenopathy if the celiac ganglia have a nodular configuration and uptake higher than bone marrow. Uptake in celiac, cervical, and sacral ganglia has been reported previously as an important pitfall in Ga-PSMA-HBED-CC PET for prostate cancer. In our patients, only celiac ganglion uptake was visualized. Advances in PET scanner technology may cause physiologic uptake of F-fluciclovine in celiac ganglia to become more visually distinguishable from muscular uptake in adjacent diaphragmatic crura.

Topics: Aged; Biological Transport; Carboxylic Acids; Cyclobutanes; False Positive Reactions; Ganglia, Sympathetic; Humans; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms

We present a case demonstrating increased diagnostic difficulty in interpretation of F-flucyclovine PET/CT in a patient with beta-thalassemia. F-flucyclovine PET/CT demonstrated diffuse increased marrow activity. Additional findings of extramedullary hematopoiesis including intrasplenic extramedullary hematopoiesis are presented. Despite the background marrow activity, an osseous metastatic lesion representing recurrent metastatic prostate carcinoma was identified. This case demonstrates a spectrum of findings of F-flucyclovine uptake in thalassemia, which increased the difficulty of identifying recurrent disease.

Topics: Aged; beta-Thalassemia; Carboxylic Acids; Cyclobutanes; Hematopoiesis, Extramedullary; Humans; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Recurrence

To compare the diagnostic performance of Fluciclovine PET/CT and 99mTc-MDP bone scan in detecting bone metastases in patients with metastatic prostate cancer.. Patients with metastatic prostate cancer who had both Fluciclovine PET/CT and bone scan within 3-month interval between October 2017 and October 2018 in our center were retrospectively reviewed. Exclusion criteria included separate concurrent cancer, or prostate-specific antigen were more than two-fold difference with an absolute difference >1 ng/ml between the two image studies. All abnormal bone lesions on either scan were compared. The findings were verified by available pathology and 4-month clinical follow-up.. A total of 106 patients with 106 dual scans were included in this study. 80/106 (75%) had concordant findings, whereas 26/106 (25%) had discordant findings. Of the discordant findings, 13/26 (50%) had false-positive findings on bone scan but negative on Fluciclovine PET/CT, 3/26 (11.5%) had positive lesions on Fluciclovine PET/CT but negative on bone scan, 8/26 (30.8%) had more positive lesions on Fluciclovine PET/CT than bone scan, and 2/26 (7.7%) with false-positive lesions on Fluciclovine PET/CT but negative on bone scan. The sensitivity, specificity, positive predictive value and negative predictive value for bone scan were 79%, 86%, 45% and 96%, respectively; and 100%, 98%, 89% and 100% in Fluciclovine PET/CT, respectively.. Our results demonstrated that Fluciclovine PET/CT detected more bone metastases than bone scan. Importantly, there were no lesions identified by bone scan that was missed by Fluciclovine PET/CT. With the extra capacity of detecting soft tissue metastasis in PET/CT, Fluciclovine PET/CT may render bone scan unnecessary to investigate metastatic prostate cancer.

Topics: Aged; Aged, 80 and over; Biopsy; Bone and Bones; Bone Neoplasms; Carboxylic Acids; Cyclobutanes; False Negative Reactions; False Positive Reactions; Humans; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Retrospective Studies; Technetium Tc 99m Medronate

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

Prostate imaging with F-labeled 1-amino-3-fluorocyclobutane-1-carboxylic acid (FACBC, F-fluciclovine) PET/CT scan (Axumin) was recently approved by the US Food and Drug Administration for men with suspected prostate cancer recurrence based on elevated blood prostate-specific antigen levels following prior treatment. We present a rare case of a 77-year-old man with suspected recurrent prostate cancer with an incidental finding of advanced-stage breast cancer showing different degrees of F-fluciclovine uptake.

Topics: Aged; Biological Transport; Breast Neoplasms, Male; Carboxylic Acids; Cyclobutanes; Humans; Incidental Findings; Male; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Recurrence

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Topics: Bayes Theorem; Carboxylic Acids; Cyclobutanes; Humans; Image Processing, Computer-Assisted; Male; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostate; Prostatic Neoplasms; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies

A 58-year-old man with Gleason 4+3 prostate cancer was initially treated by radical prostatectomy followed by salvage radiotherapy to the prostate bed for postoperative biochemical failure. One year later, F-fluorocholine PET/CT detected a pelvic lymph node recurrence, which was treated with radiation therapy and 6 months of androgen deprivation. PSA started to rise again 18 months later, but F-fluciclovine PET/CT failed to demonstrate the site of recurrence at a PSA of 0.63 ng/mL. However, Ga-PSMA PET/CT revealed a single positive 4-mm perirectal lymph node (PSA 0.80 ng/mL at time of scan), in retrospect anatomically apparent but negative on F-fluciclovine PET/CT.

Topics: Carboxylic Acids; Cyclobutanes; Edetic Acid; Gallium Isotopes; Gallium Radioisotopes; Humans; Lymphatic Metastasis; Male; Middle Aged; Oligopeptides; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Recurrence; Salvage Therapy

To investigate the disease detection rate, diagnostic performance and interobserver agreement of fluciclovine (. Twenty-four patients with biochemical failure after non-prostatectomy definitive therapy, 16/24 of whom had undergone brachytherapy, underwent fluciclovine PET-CT and mpMR with interpretation by expert readers blinded to patient history, PSA and other imaging results. Reference standard was established via a multidisciplinary truth panel utilizing histology and clinical follow-up (22.9 ± 10.5 months) and emphasizing biochemical control. The truth panel was blinded to investigative imaging results. Diagnostic performance and interobserver agreement (kappa) for the prostate and extraprostatic regions were calculated for each of 2 readers for PET-CT (P1 and P2) and 2 different readers for mpMR (M1 and M2).. On a whole body basis, the detection rate for fluciclovine PET-CT was 94.7% (both readers), while it ranged from 31.6-36.8% for mpMR. Kappa for fluciclovine PET-CT was 0.90 in the prostate and 1.0 in the extraprostatic regions. For mpMR, kappa was 0.25 and 0.74, respectively. In the prostate, 22/24 patients met the reference standard with 13 malignant and 9 benign results. Sensitivity, specificity and positive predictive value (PPV) were 100.0%, 11.1% and 61.9%, respectively for both PET readers. For mpMR readers, values ranged from 15.4-38.5% for sensitivity, 55.6-77.8% for specificity and 50.0-55.6% for PPV. For extraprostatic disease determination, 18/24 patients met the reference standard. Sensitivity, specificity and PPV were 87.5%, 90.0% and 87.5%, respectively, for fluciclovine PET-CT, while for mpMR, sensitivity ranged from 50 to 75%, specificity 70-80% and PPV 57-75%.. The disease detection rate for fluciclovine PET-CT in non-prostatectomy patients with biochemical failure was 94.7% versus 31.6-36.8% for mpMR. For extraprostatic disease detection, fluciclovine PET-CT had overall better diagnostic performance than mpMR. For the treated prostate, fluciclovine PET-CT had high sensitivity though low specificity for disease detection, while mpMR had higher specificity, though low sensitivity. Interobserver agreement was also higher with fluciclovine PET-CT compared with mpMR.

Topics: Aged; Aged, 80 and over; Brachytherapy; Carboxylic Acids; Cyclobutanes; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Observer Variation; Positron Emission Tomography Computed Tomography; Prospective Studies; Prostatic Neoplasms; Radiopharmaceuticals; Reference Standards; Sensitivity and Specificity

F-fluciclovine is a synthetic amino acid radiotracer that has recently been approved in Europe and the United States for PET imaging in men with biochemical recurrence (BCR) of prostate cancer after prior definitive treatment. Accurate identification of the sites of disease in patients presenting with BCR of prostate cancer is important in determining the appropriate treatment. Bone is the most frequent site of metastatic disease in patients with prostate cancer.. We conducted a comprehensive review of the available preclinical and clinical data on the diagnostic performance of F-fluciclovine PET/CT in an attempt to draw practical and general conclusions on the utility and limitations of F-fluciclovine PET/CT in localization of osseous metastatic disease in prostate cancer.. The cumulative preclinical data and results of some retrospective and 2 prospective clinical studies suggest that F-fluciclovine can detect early bone marrow involvement in patients with BCR of prostate cancer and negative prior bone-specific imaging findings.. F-fluciclovine PET/CT seems to offer useful information for early detection of bone metastases in men with BCR of prostate cancer. Additional investigations will be needed to compare the diagnostic performance of F-fluciclovine PET/CT to other standard and novel imaging methods in initial staging, BCR, and castrate-resistant phases of disease.

Topics: Aged; Bone Neoplasms; Carboxylic Acids; Cyclobutanes; Humans; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals

We investigated if previously demonstrated inhibition of fluciclovine (

Topics: Animals; Biological Transport; Carboxylic Acids; Cell Line, Tumor; Cyclobutanes; Heterografts; Humans; Luminescence; Male; Mice; Mice, Nude; Positron Emission Tomography Computed Tomography; Prostate; Prostatic Neoplasms

Prostate cancer is one of the most common cancers affecting men worldwide with a high recurrence rate following therapy. F-fluciclovine, is a US Food and Drug Administration-approved radiopharmaceutical for PET imaging in biochemically recurrent prostate cancer. It targets increased amino acid transporters in the cell membrane of cancer cells. We report a case of incidentally detected hepatocellular carcinoma showing F-fluciclovine uptake in a 71-year-old man with biochemically recurrent prostate cancer.

Topics: Aged; Biological Transport; Carboxylic Acids; Carcinoma, Hepatocellular; Cyclobutanes; Humans; Incidental Findings; Liver Neoplasms; Male; Positron Emission Tomography Computed Tomography; Prostatic 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

The American College of Radiology (ACR) and American College of Nuclear Medicine (ACNM) collaborated to develop a clinical practice document for the performance of fluciclovine positron-emission tomography (PET) / computed tomography (CT) in the evaluation of patients with suspected prostate cancer recurrence based on the elevation of prostate-specific antigen (PSA) level (biochemical recurrence) after prior therapy. Prostate cancer is the third leading cause of cancer death in the United States. Up to 50% of patients diagnosed with prostate cancer will develop biochemical failure after initial therapy. The differentiation of local from extraprostatic recurrence plays a critical role in patient management. The use of functional imaging targeting features of cancer metabolism has proven highly useful in this regard. Amino acid transport is upregulated in prostate cancer. Fluciclovine (anti-1-amino-3-F-18-fluorocyclobutane-1-carboxylic acid, FACBC, Axumin™) is an artificial amino acid PET tracer which demonstrates utility in the diagnosis of recurrent prostate cancer with significant added value to conventional imaging.

Topics: Carboxylic Acids; Cyclobutanes; Fluorine Radioisotopes; Humans; Male; Neoplasm Recurrence, Local; Nuclear Medicine; Positron Emission Tomography Computed Tomography; Practice Guidelines as Topic; Prostatic Neoplasms; Radiology; Radiopharmaceuticals; Societies, Medical

We present the case of a 79-year-old man with an elevated postprostatectomy prostate-specific antigen level who was sequentially imaged with positron emission tomography/computed tomography (PET/CT) using

Topics: Aged; Antigens, Surface; Carboxylic Acids; Cyclobutanes; Fluorine Radioisotopes; Glutamate Carboxypeptidase II; Humans; Lysine; Male; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostate; Prostatic Neoplasms; Radiopharmaceuticals; Urea

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

A 66-year-old man presented with biochemical recurrence of prostate cancer and underwent F-fluciclovine PET/CT to detect sites of recurrence. He had a history of resected truncal stage IIIC malignant melanoma, with bilateral axillary node involvement on sentinel node biopsy, in complete remission for 3 years. F-fluciclovine PET/CT demonstrated an incidental fluciclovine-avid right axillary node (SUVmax = 4.3). Diagnostic sampling confirmed recurrent malignant melanoma.

Topics: Carboxylic Acids; Cyclobutanes; Humans; Incidental Findings; Male; Melanoma; Middle Aged; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Recurrence; Sentinel Lymph Node Biopsy

Topics: Carboxylic Acids; Cyclobutanes; Humans; Male; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostatic Neoplasms

To compare the diagnostic performance of the synthetic amino acid analogue PET radiotracer anti-3-[(18)F]FACBC (fluciclovine) with that of CT in the detection of recurrent prostate carcinoma.. This was a retrospective analysis of 53 bone scan-negative patients with suspected recurrent prostate carcinoma who underwent fluciclovine PET/CT and routine clinical CT within 90 days of each other. The correlation between imaging findings and histology and clinical follow-up was evaluated. Positivity rates and diagnostic performance were calculated for fluciclovine PET/CT and CT.. Of 53 fluciclovine PET/CT and 53 CT examinations, 41 (77.4 %) and 10 (18.9 %), respectively, had positive findings for recurrent disease. Positivity rates were higher with fluciclovine PET/CT than with CT at all prostate-specific antigen (PSA) levels, PSA doubling times and original Gleason scores. In the prostate/bed, fluciclovine PET/CT was true-positive in 31 and CT was true-positive in 4 of 51 patients who met the reference standard. In extraprostatic regions, fluciclovine PET/CT was true-positive in 12 and CT was true-positive in 3 of 41 patients who met the reference standard. Of the 43 index lesions used to prove positivity, 42 (97.7 %) had histological proof. In 51 patients with sufficient follow-up to calculate diagnostic performance in the prostate/bed, fluciclovine PET/CT demonstrated a sensitivity of 88.6 %, a specificity of 56.3 %, an accuracy of 78.4 %, a positive predictive value (PPV) of 81.6 %, and a negative predictive value (NPV) of 69.2 %; the respective values for CT were 11.4 %, 87.5 %, 35.3 %, 66.7 % and 31.1 %. In 41 patients with sufficient follow-up to calculate diagnostic performance in extraprostatic regions, fluciclovine PET/CT demonstrated a sensitivity of 46.2 %, a specificity of 100 %, an accuracy of 65.9 %, a PPV of 100 %, and an NPV of 51.7 %; the respective values for CT were 11.5 %, 100 %, 43.9 %, 100 % and 39.5 %.. The diagnostic performance of fluciclovine PET/CT in recurrent prostate cancer is superior to that of CT and fluciclovine PET/CT provides better delineation of prostatic from extraprostatic recurrence.

Topics: Aged; Bone Neoplasms; Carboxylic Acids; Cyclobutanes; Humans; Image Enhancement; Male; Middle Aged; Neoplasm Recurrence, Local; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

The aim of this study is to examine the reproducibility of anti-1-amino-3-[(18)F]fluorocyclobutane-1-carboxylic acid (anti-3-[(18)F]FACBC) quantitative measurements in key background structures and untreated malignant lesions.. Retrospective review of 14 patients who underwent follow-up anti-3-[(18)F]FACBC positron emission tomography-X-ray computed tomography (PET-CT) for prostate carcinoma recurrence. Standard uptake values (SUV) were measured in both original and follow-up scans in key background structures and untreated malignant lesions. Absolute and percent mean difference in SUV between scans and interclass correlation coefficients (ICC) were also computed.. Mean (±SD, range) scan interval was 17.4 months (±7.1, 4-29). %Mean difference in SUVmean was <20 % in background structures with low absolute differences. ICCs were >0.6 except for early-phase blood pool (ICC = 0.4). SUVmax in malignant lesions without interim therapy increased or remained stable over time.. Despite variable time interval between scans, FACBC PET-CT demonstrates acceptable reproducibility in key background structures. Untreated malignant lesions showed stable or increased uptake over time. A formal test-retest study is planned.

Topics: Aged; Carboxylic Acids; Cyclobutanes; Follow-Up Studies; Humans; Male; Middle Aged; Positron-Emission Tomography; Prostatic Neoplasms; Reproducibility of Results; Tomography, X-Ray Computed

In recent years, a new PET compound (anti-3-(18)F-FACBC or (18)F-fluciclovine) was tested for the detection of prostate cancer relapse. Despite very promising results, only preliminary data were available with regard to the comparison to (11)C-choline. The aim of this study was to compare the detection rate of (18)F-FACBC and (11)C-choline in patients presenting a biochemical relapse.. Fifty patients radically treated for prostate cancer and presenting with rising prostate-specific antigen (PSA) levels were consecutively and prospectively enrolled. All the patients were out of hormonal therapy and underwent both (11)C-choline PET/CT and (18)F-fluciclovine PET/CT within 1 week. The results were compared in terms of detection rate on a patient and lesion basis. Furthermore, a more detailed analysis regarding local, lymph node, and bone relapse was performed.. On a patient-based analysis, (18)F-fluciclovine detection turned out to be significantly superior to (11)C-choline (P < 0.000001). This result was also true on lesion, lymph node, bone lesion, and local relapse analysis (P < 0.0001 in all the cases). There was no significant difference in terms of target to background of positive lesions between (11)C-choline and (18)F-fluciclovine. When the patients were divided into groups with different PSA levels, (18)F-fluciclovine had a superior detection rate for low, intermediate, and high PSA levels.. In our experimental conditions, (18)F-fluciclovine provided a statistically significant better performance in terms of lesion detection rate as compared with (11)C-choline. However, more studies are required to evaluate the clinical significance of these results in terms of sensitivity, specificity, and accuracy.

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

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

The aim of our study was to compare the detection rate of anti-3-18F-FACBC PET/CT in comparison with 11C-choline PET/CT in the evaluation of disease recurrence of PCa after radical prostatectomy.. Twenty-eight consecutive patients with biochemical relapse after radical prostatectomy were submitted to anti-3-18F-FACBC PET/CT and 11C-choline PET/CT to evaluate the site of disease recurrence. Androgen deprivation therapy was avoided in all cases. The primary end point was the overall detection rate of the 2 radiotracers. A patient-based analysis and a lesion-based analysis was performed. The target to background ratio (TBR) of each lesion was reported.. At the time of PET scan, mean age was 67 years and mean prostate specific antigen (PSA) relapse was 2.9 ng/mL (range: 0.2-14.6). In patient-based analyses, 11C-choline PET/CT was positive in 5 patients and negative in 23 (detection rate = 17.8%) and anti-3-18F-FACBC PET/CT was positive in 10 patients and negative in 18 (detection rate = 35.7%). All lesions that were positive using 11C-choline were positive using anti-3-18F-FACBC PET/CT but with the latter radiotracer, 11 (61.1%) additional tumors were identified including 5 (17.8%) additional patients. The TBR of anti-3-18F-FACBC was greater than 11C-choline in 15 of 18 lesions, confirming a better image quality and contrast.. This preliminary study demonstrated that the detection rate of anti-3-18F-FACBC PET/CT is greater in comparison with 11C-choline, with approximately 20% of additional patients and approximately 60% additional lesions detected. Further studies, however, are required to assess the exact added value of this new tracer.

Topics: Aged; Carbon Radioisotopes; Carboxylic Acids; Choline; Cyclobutanes; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Radiopharmaceuticals; Tomography, X-Ray Computed

We aimed to elucidate trans-1-amino-3-[(18)F]fluorocyclobutanecarboxylic acid (anti-[(18)F]FACBC) uptake mechanisms in inflammatory and tumor cells, in comparison with those of L-[methyl-(11)C]methionine ([(11)C]Met) and 2-deoxy-2-[(18)F]fluoro-D-glucose ([(18)F]FDG).. Using carbon-14-labeled tracers, in vitro time-course, pH dependence, and competitive inhibition uptake experiments were performed in rat inflammatory (T cells, B cells, granulocytes, macrophages), prostate cancer (MLLB2), and glioma (C6) cells.. Anti-[(14)C]FACBC uptake ratios of T/B cells to tumor cells were comparable, while those of granulocytes/macrophages to tumor cells were lower than those for [(14)C]FDG. Over half of anti-[(14)C]FACBC uptake by T/B and tumor cells was mediated by Na(+)-dependent amino acid transporters (system ASC), whereas most [(14)C]Met transport in all cells was mediated by Na(+)-independent carriers (system L).. The low anti-[(18)F]FACBC accumulation in granulocytes/macrophages may be advantageous in discriminating inflamed regions from tumors. The significant anti-[(18)F]FACBC uptake in T/B cells may cause false-positives in some cancer patients who undergo FACBC-positron emission tomography (PET).

Topics: Animals; Carboxylic Acids; Cell Line, Tumor; Cyclobutanes; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Hydrogen-Ion Concentration; Inflammation; Male; Methionine; Prostatic Neoplasms; Rats

We present the first case of salvage retroperitoneal lymph node dissection based on the results of (18)F-FACBC PET/CT performed for a prostate-specific antigen relapse after radical prostatectomy. The patients underwent (11)C-choline PET/CT, which turned out negative, while (18)F-FACBC PET/CT visualized two lymph node metastases confirmed at pathological examination. Preliminary clinical reports showed an improvement in the detection rate of 20-40% for (18)F-FACBC in comparison with (11)C-choline, rendering the (18)F-FACBC the potential radiotracer of the future. Salvage surgery for prostate cancer is a fascinating but controversial approach. New diagnostic tools may improve its potential by increasing the assessment and the selection of the patients.

Topics: Carbon Radioisotopes; Carboxylic Acids; Choline; Cyclobutanes; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Salvage Therapy; Tomography, X-Ray Computed; Treatment Outcome

To characterize uptake of 1-amino-3-fluorine 18-fluorocyclobutane-1-carboxylic acid ((18)F FACBC) in patients with localized prostate cancer, benign prostatic hyperplasia (BPH), and normal prostate tissue and to evaluate its potential utility in delineation of intraprostatic cancers in histopathologically confirmed localized prostate cancer in comparison with magnetic resonance (MR) imaging.. Institutional review board approval and written informed consent were obtained for this HIPAA-compliant prospective study. Twenty-one men underwent dynamic and static abdominopelvic (18)F FACBC combined positron emission tomography (PET) and computed tomography (CT) and multiparametric (MP) 3-T endorectal MR imaging before robotic-assisted prostatectomy. PET/CT and MR images were coregistered by using pelvic bones as fiducial markers; this was followed by manual adjustments. Whole-mount histopathologic specimens were sliced with an MR-based patient-specific mold. (18)F FACBC PET standardized uptake values (SUVs) were compared with those at MR imaging and histopathologic analysis for lesion- and sector-based (20 sectors per patient) analysis. Positive and negative predictive values for each modality were estimated by using generalized estimating equations with logit link function and working independence correlation structure.. (18)F FACBC tumor uptake was rapid but reversible. It peaked 3.6 minutes after injection and reached a relative plateau at 15-20 minutes (SUVmax[15-20min]). Mean prostate tumor SUVmax(15-20min) was significantly higher than that of the normal prostate (4.5 ± 0.5 vs 2.7 ± 0.5) (P < .001); however, it was not significantly different from that of BPH (4.3 ± 0.6) (P = .27). Sector-based comparison with histopathologic analysis, including all tumors, revealed sensitivity and specificity of 67% and 66%, respectively, for (18)F FACBC PET/CT and 73% and 79%, respectively, for T2-weighted MR imaging. (18)F FACBC PET/CT and MP MR imaging were used to localize dominant tumors (sensitivity of 90% for both). Combined (18)F FACBC and MR imaging yielded positive predictive value of 82% for tumor localization, which was higher than that with either modality alone (P < .001).. (18)F FACBC PET/CT shows higher uptake in intraprostatic tumor foci than in normal prostate tissue; however, (18)F FACBC uptake in tumors is similar to that in BPH nodules. Thus, it is not specific for prostate cancer. Nevertheless, combined (18)F FACBC PET/CT and T2-weighted MR imaging enable more accurate localization of prostate cancer lesions than either modality alone.

Topics: Adult; Aged; Carboxylic Acids; Cyclobutanes; Humans; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Predictive Value of Tests; Prospective Studies; Prostatic Hyperplasia; Prostatic Neoplasms; Radiopharmaceuticals; Tomography, X-Ray Computed

Trans-1-amino-3-[(18)F]fluorocyclobutanecarboxylic acid (anti-[(18)F]FACBC) is a positron emission tomography (PET) tracer used to visualize prostate cancer (PCa). In this study, we investigated the differences in anti-[(18)F]FACBC accumulation between metastatic and inflamed lymph node (LN) lesions.. A PCa LN metastasis (PLM) model was developed by inoculating a rat PCa cell line, MAT-Ly-Lu-B2, into popliteal LNs of Copenhagen rats. Acute lymphadenitis (AL) was induced by injecting concanavalin A (Con A) into the hind footpad, and chronic lymphadenitis (CL) was induced by daily injection of Con A into the tissues surrounding the popliteal LNs for 2weeks. Main lesions of all animal models were established in lumbar and/or inguinal LNs. Biodistribution and dynamic PET imaging data were acquired after tracer injection. T2-weighted magnetic resonance (MR) images were registered with PET images.. In the biodistribution study, the uptake ratios of PLM-to-lymphadenitis in lesional lumbar and inguinal LNs were 0.97-1.57 and 1.47-2.08 at 15 and 60min post-anti-[(18)F]FACBC injection respectively. In PET imaging, the lesional lumbar LNs of CL and PLM, but not of AL, were visualized on anti-[(18)F]FACBC-PET/MR fusion images without disturbance from radioactivity from urine, and　the rank order of anti-[(18)F]FACBC accumulation at 50-60 post-injection in lesional lumbar LNs was PLM>CL>AL.. Anti-[(18)F]FACBC accumulation in LNs with PLM was higher than that in inflamed LNs.. The study showed that although low but significant levels of anti-[(18)F]FACBC uptake by chronic inflamed lesions might cause false-positives in anti-[(18)F]FACBC-PET in some PCa patients, uptake of the tracer at acutely inflamed sites was minimal.. The findings of this study suggest the potential of Anti-[(18)F]FACBC for distinguishing between tumors and acute inflammation in clinical practice.

Topics: Animals; Carboxylic Acids; Cell Line, Tumor; Cyclobutanes; Lymphadenitis; Lymphatic Metastasis; Male; Positron-Emission Tomography; Prostatic Neoplasms; Rats; Tissue Distribution

In this retrospective analysis we assessed the role of [(18)F]-FACBC-PET/CT in the prostatic cancer staging.. 30 first [(18)F]-FACBC-PET/CT images of 26 patients (68.1 ± 5.8 years) were analyzed. PET/CT findings were compared with PSA concentrations, with PSA doubling times (PDT), and with correlative imaging.. On 16 [(18)F]-FACBC (53.3%) scans, 58 metabolically active lesions were found. 12 (20.7%) lesions corresponding to the local relapse were found in prostate/prostate bed and seminal vesicles, 9 (15.5%) lesions were located in regional lymph nodes, 10 (17.2%) were located in distal lymph nodes, and 26 (44.8%) metabolically active lesions were found in the skeleton. In one case, focal uptake was found in the brain, confirmed further on MRI as meningioma. The mean S-PSA level in patients with positive [(18)F]-FACBC findings was 9.5 ± 16.9  μ g/L (0.54-69  μ g/L) and in patients with negative [(18)F]-FACBC findings was 1.96 ± 1.87  μ g/L (0.11-5.9  μ g/L), but the difference was not statistically significant. However, the PSA doubling time (PDT) in patients with positive findings was significantly shorter than PDT in patients with negative findings: 3.25 ± 2.09 months (0.3-6 months) versus 31.2 ± 22.02 months (8-84 months), P < 0.0001. There was a strong positive correlation between PSA value and number of metabolically active lesions (R = 0.74) and a negative correlation between PDT and number of metabolically active lesions (R = -0.56). There was a weak negative correlation between PDT and SUVmax⁡ (R = -0.30).. According to our preliminary clinical experience, [(18)F]-FACBC-PET may play a role in in vivo restaging of an active prostate cancer, especially in patients with a short S-PSA doubling time.

Topics: Aged; Carboxylic Acids; Cyclobutanes; Diagnostic Imaging; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Positron-Emission Tomography; Prostate-Specific Antigen; Prostatic Neoplasms; Radiography; Radiopharmaceuticals

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

Topics: Carboxylic Acids; Cyclobutanes; Humans; Male; Middle Aged; Multimodal Imaging; Neoplasm Recurrence, Local; Neoplasm Staging; Positron-Emission Tomography; Prognosis; Prostate-Specific Antigen; Prostatic Neoplasms; Radiopharmaceuticals; Tomography, X-Ray Computed

We investigated the mechanisms of trans-1-amino-3-fluoro[1-(14)C]cyclobutanecarboxylic acid (anti-[(14)C]FACBC) transport by human-derived prostate cancer (PCa) cells and normal human prostatic epithelial cells (PrECs).. Using PCa cells (DU145, PC-3, LNCaP) and PrECs, we performed the following in vitro experiments: time-course, kinetics, competitive inhibition by synthetic/naturally occurring amino acids (AAs), exchange transport with synthetic/naturally occurring AAs and pH-dependency of anti-[(14)C]FACBC uptake. We also examined the amino acid transporter (AAT) expression using flow cytometry.. The uptake of anti-[(14)C]FACBC by LNCaP and DU145 cells was higher than that by PC-3 and PrECs. The K(m) values for anti-[(14)C]FACBC were 64.4 and 191.7 μmol/L in the DU145 cells and PrECs, respectively. Total levels of anti-[(14)C]FACBC uptake were positively correlated with the expression level of system ASC in PCa cells. The contributions of Na(+)-dependent AATs to anti-[(14)C]FACBC uptake were greater than those of Na(+)-independent AATs, especially in PCa cells. In the presence of Na(+), glutamine and serine showed the strongest inhibitory effect against anti-[(14)C]FACBC uptake, suggesting that system ASC, especially ASCT2, is an important AAT for anti-[(14)C]FACBC. In contrast, phenylalanine and 2-amino-bicyclo[2,2,1]heptane-2-carboxylic acid, but not N-ethylmaleimide, almost completely inhibited the anti-[(14)C]FACBC uptake in the absence of Na(+), indicating the contribution of LAT1. In the exchange transport experiments, glutamine showed the strongest transstimulation of intracellular anti-[(14)C]FACBC efflux in DU145 cells. Furthermore, the contributions of Na(+)-independent AATs to the uptake of anti-[(14)C]FACBC in DU145 and PrECs were greater under acidic pH conditions than under neutral or alkaline pH conditions.. Total uptake of anti-[(14)C]FACBC by PCa cells correlates with the expression level of system ASC in PCa cells. Furthermore, LAT1 is an important transport system for anti-[(14)C]FACBC uptake, especially in an acidic environment, such as the intra-tumoural environment.

Topics: Amino Acid Transport Systems; Amino Acids; Biological Transport; Carbon Radioisotopes; Carboxylic Acids; Cyclobutanes; Epithelial Cells; Flow Cytometry; Humans; Male; Prostate; Prostatic Neoplasms

To compare the diagnostic performance of the synthetic amino acid analog radiotracer anti-1-amino-3-fluorine 18-fluorocyclobutane-1-carboxylic acid (anti-3-(18)F-FACBC) with that of indium 111 ((111)In)-capromab pendetide in the detection of recurrent prostate carcinoma.. This prospective study was approved by the institutional review board and complied with HIPAA guidelines. Written informed consent was obtained. Fifty patients (mean age, 68.3 years ± 8.1 [standard deviation]; age range, 50-90 years) were included in the study on the basis of the following criteria: (a) Recurrence of prostate carcinoma was suspected after definitive therapy for localized disease, (b) bone scans were negative, and (c) anti-3-(18)F-FACBC positron emission tomography (PET)/computed tomography (CT) and (111)In-capromab pendetide single photon emission computed tomography (SPECT)/CT were performed within 6 weeks of each other. Studies were evaluated by two experienced interpreters for abnormal uptake suspicious for recurrent disease in the prostate bed and extraprostatic locations. The reference standard was a combination of tissue correlation, imaging, laboratory, and clinical data. Diagnostic performance measures were calculated and tests of the statistical significance of differences determined by using the McNemar χ(2) test as well as approximate tests based on the difference between two proportions.. For disease detection in the prostate bed, anti-3-(18)F-FACBC had a sensitivity of 89% (32 of 36 patients; 95% confidence interval [CI]: 74%, 97%), specificity of 67% (eight of 12 patients; 95% CI: 35%, 90%), and accuracy of 83% (40 of 48 patients; 95% CI: 70%, 93%). (111)In-capromab pendetide had a sensitivity of 69% (25 of 36 patients; 95% CI: 52%, 84%), specificity of 58% (seven of 12 patients; 95% CI: 28%, 85%), and accuracy of 67% (32 of 48 patients; 95% CI: 52%, 80%). In the detection of extraprostatic recurrence, anti-3-(18)F-FACBC had a sensitivity of 100% (10 of 10 patients; 95% CI: 69%, 100%), specificity of 100% (seven of seven patients; 95% CI: 59%, 100%), and accuracy of 100% (17 of 17 patients; 95% CI: 80%, 100%). (111)In-capromab pendetide had a sensitivity of 10% (one of 10 patients; 95% CI: 0%, 45%), specificity of 100% (seven of seven patients; 95% CI: 59%, 100%), and accuracy of 47% (eight of 17 patients; 95% CI: 23%, 72%).. anti-3-(18)F-FACBC PET/CT was more sensitive than (111)In-capromab pendetide SPECT/CT in the detection of recurrent prostate carcinoma and is highly accurate in the differentiation of prostatic from extraprostatic disease.. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11102023/-/DC1.

Topics: Aged; Aged, 80 and over; Antibodies, Monoclonal; Carboxylic Acids; Chi-Square Distribution; Cyclobutanes; Humans; Indicators and Reagents; Indium Radioisotopes; Male; Middle Aged; Neoplasm Recurrence, Local; Positron-Emission Tomography; Predictive Value of Tests; Prospective Studies; Prostatic Neoplasms; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Trans-1-amino-3-(18)F-fluorocyclobutanecarboxylic acid (anti-(18)F-FACBC) is an amino acid PET tracer that has shown promise for visualizing prostate cancer. Therefore, we aimed to clarify the anti-(18)F-FACBC transport mechanism in prostate cancer cells. We also studied the fate of anti-(18)F-FACBC after it is transported into cells.. For convenience, because of their longer half-lives, (14)C compounds were used instead of (18)F-labeled tracers. Trans-1-amino-3-fluoro-1-(14)C-cyclobutanecarboxylic acid ((14)C-FACBC) uptake was examined in human prostate cancer DU145 cells with the following substrates of amino acid transporters: α-(methylamino) isobutyric acid (a system A-specific substrate) and 2-amino-2-norbornanecarboxylic acid (a system L-specific substrate). The messenger RNA expression of amino acid transporters in human prostate cancer specimens was analyzed by complementary DNA microarray and quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). Gene expression in DU145 cells was analyzed by qRT-PCR. We also examined the knockdown effect of the amino acid transporters system ASC transporter 2 (ASCT2) and sodium-coupled neutral amino acid transporter 2 (SNAT2) on (14)C-FACBC uptake. In addition, the possibility of (14)C-FACBC incorporation into proteins was examined.. (14)C-FACBC uptake by DU145 cells was markedly decreased to approximately 20% in the absence of Na(+), compared with that in its presence, indicating that Na(+)-dependent transporters are mainly responsible for the uptake of this tracer. Moreover, 2-amino-2-norbornanecarboxylic acid inhibited the transport of (14)C-FACBC to the basal level in Na(+)-free buffer. In contrast, α-(methylamino) isobutyric acid did not inhibit (14)C-FACBC accumulation in DU145 cells. Human prostate tumor specimens and DU145 cells had similar messenger RNA expression patterns of amino acid transporter genes. Although SNAT2 and ASCT2 are 2 major amino acid transporters expressed in prostate tumor tissues and DU145 cells, ASCT2 knockdown using small interfering RNA was more effective in lowering (14)C-FACBC transport than SNAT2. Almost all intracellular (14)C-FACBC was recovered from the nonprotein fraction.. ASCT2, which is a Na(+)-dependent amino acid transporter, and to a lesser extent Na(+)-independent transporters play a role in the uptake of (14)C-FACBC by DU145 cells. Among the Na(+)-independent transporters, system L transporters are also involved in the transport of (14)C-FACBC. Moreover, (14)C-FACBC is not incorporated into proteins in cells. These findings suggest a possible mechanism of anti-(18)F-FACBC PET for prostate cancer.

Topics: Amino Acid Transport System ASC; Binding, Competitive; Biological Transport; Carboxylic Acids; Cell Line, Tumor; Cyclobutanes; Gene Expression Profiling; Humans; Intracellular Space; Male; Minor Histocompatibility Antigens; Oligonucleotide Array Sequence Analysis; Prostatic Neoplasms; RNA, Messenger; RNA, Small Interfering

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

Anti-1-amino-3-F-18 fluorocyclobutane-1-carboxylic acid (FACBC) is a novel radiotracer, which has shown some promise for use with positron emission tomography (PET)/computed tomography (CT) for visualizing prostate cancer. Here we describe a case of a prostate cancer patient who underwent radiation treatment and had an FACBC scan obtained as part of a pilot study.. We explored the potential impact of FACBC on treatment planning. We registered the FACBC acquisition with the PET/CT, which required a simple translation. Then, we did a deformable image registration of the PET/CT with the planning CT-this process allowed the FACBC-defined gross tumor volume (GTVFACBC) to be projected into the planning CT. An intensity-modulated radiotherapy (IMRT) plan (plan A) not including GTVFACBC (with final dose to 81.0 Gy) was generated, as was an IMRT plan including the GTVFACBC to a final dose of 86.4 Gy (plan B). Target coverage and normal tissue dose volume histogram (DVH) endpoints were tabulated.. In this particular patient, bladder constraints could not be met on any plan due to anatomic limitations. However, the impact on the rectal DVH could be assessed, and inclusion of the GTVFACBC did permit rectal DVH constraints to be met in plan B while maintaining target coverage and inhomogeneity constraints.. In our test case, it was feasible to use FACBC to guide IMRT, and highlights the role of deformable image registration of the PET/CT with the planning CT. These findings can guide future studies incorporating FACBC into treatment planning.

Topics: Carboxylic Acids; Cyclobutanes; Humans; Male; Middle Aged; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated; Rectum; Tomography, X-Ray Computed; Treatment Outcome; Urinary Bladder

We evaluated the feasibility of anti-1-amino-3-(18)F-fluorocyclobutyl-1-carboxylic acid (anti-(18)F-FACBC) in diagnosing prostate cancer (PCa), using a rat orthotopic prostate cancer transplantation (OPCT) model. Furthermore, using in vivo experiments, we examined the potential of anti-(18)F-FACBC for differentiating between PCa and inflammation and between PCa and benign prostatic hyperplasia (BPH).. The OPCT model was developed by transplanting DU145, a human PCa cell line, into the ventral prostate of athymic F344 rats. To develop a dual PCa and inflammation (DPCI) model, MAT-Ly-Lu-B2--a rat PCa cell line--was transplanted subcutaneously into male Copenhagen rats. Streptozotocin was injected into the hind footpad of these rats for inducing popliteal lymphadenitis. For inducing the BPH, normal F344 rats were castrated and injected subcutaneously with testosterone propionate. In biodistribution studies, the rats were injected with anti-(18)F-FACBC or (18)F-FDG and sacrificed at 15 or 60 min after injection. We performed dynamic small-animal PET of the abdominal portion of the OPCT rats for 60 min after the injection of anti-(18)F-FACBC or (18)F-FDG.. The biodistribution in the OPCT rats at 60 min after injection showed that the uptake of anti-(18)F-FACBC and (18)F-FDG into the PCa tissue was 1.58 +/- 0.40 %ID/cm(3) (percentage injected dose per cm(3)) and 1.48 +/- 0.90 %ID/cm(3), respectively (P > 0.05). The accumulation of anti-(18)F-FACBC in the urinary bladder at 60 min after injection was 3.09 +/- 1.43 %ID/cm(3), whereas that of (18)F-FDG was 69.31 +/- 16.55 %ID/cm(3) (P < 0.05). Consequently, small-animal imaging with anti-(18)F-FACBC facilitated the visualization of the PCa tissue of the OPCT rats with higher contrast than (18)F-FDG. Furthermore, in comparison with (18)F-FDG, apparently higher ratios of PCa to inflammation and PCa to BPH accumulation of anti-(18)F-FACBC were demonstrated in the animal models.. FACBC PET is believed to be useful not only for the visualization of human PCa but also for differentiating between PCa and inflammation and between PCa and BHP.

Topics: Animals; Autoradiography; Carboxylic Acids; Cell Line, Tumor; Cyclobutanes; Humans; Inflammation; Male; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Rats; Rats, Inbred F344; Rats, Nude; Streptozocin; Urinary Bladder

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

Topics: Carboxylic Acids; Choline; Cyclobutanes; Fluorine Radioisotopes; Humans; Male; Positron-Emission Tomography; Prostatic Neoplasms