'Best available test': Advanced PET boosts disease-free survival in patients with prostate cancer

Incorporating advanced PET into treatment planning for patients with recurrent prostate cancer increases disease-free survival rates and should be adopted into standard practice, according to new research presented Monday.

Among those whose cancer returned after prostate removal surgery, 75% who underwent molecular imaging during treatment were cancer-free after three years. That’s compared to 63% of patients who only received traditional imaging to steer their radiation therapy. 

The new findings come by way of the Emory Molecular Prostate Imaging for Radiotherapy Enhancement, or EMPIRE-1 trial, which was presented Oct. 26 at the American Society for Radiation Oncology Annual Meeting.

“The decision to offer post-prostatectomy radiation therapy is complex because conventional imaging can leave unanswered questions on the best approach to treatment planning,” co-principal investigator Ashesh B. Jani, MD, a professor of radiation oncology at the Winship Cancer Institute of Emory University in Atlanta, said in a statement. “What this research has found is that integrating advanced molecular imaging into the treatment planning process allows us to do a better job of selecting patients for radiation therapy, guiding radiation treatment decisions and planning and ultimately, keeping patients' cancer under control."

Prostate cancer is a leading killer of men in the United States, with an estimated 1 in 9 liable to receive such a diagnosis. Imaging approaches such as CT or MRI are usually used to plan out radiation therapy decisions, but PET can more accurately detect the location of growing tumors.

As part of their study, Jani et al. enrolled 165 patients who had received prostatectomies but later showed abnormal prostate-specific antigen test scores indicating cancer recurrence. Each participant received traditional imaging (bone scan, CT, or MRI) for treatment planning.

They were then randomized into two groups: the first received radiation therapy based on initial planning, while the second received treatment based on PET scans performed with a novel fluciclovine radiotracer.

After a three year follow-up, the disease-free survival rate was higher among those who received molecular imaging (75.5%) compared to patients in the conventional imaging group (63%).

About midway through the study, the U.S. Food and Drug Administration approved Fluciclovine. It has not been widely adopted as the standard for planning prostate cancer treatment, but should be, the authors argued. At least until an up and coming challenger proves otherwise.

“Fluciclovine PET has become the best available test,” co-principal investigator David M. Schuster, MD, a nuclear rad specialist at Emory, said on Monday. “But now there’s an even newer kid on the block. In EMPIRE-2, we’re building on the results of EMPIRE-1 by comparing PSMA with fluciclovine to see which one of these radiotracers improves cancer control better.”