Researchers examine patient disparities, utilization of Fluciclovine-PET imaging

The use of [18F]Fluciclovine-PET imaging is steadily increasing in patients with suspected prostate cancer, but a new single-center study published in the Journal of the American College of Radiology found some have more difficulty undergoing the exam than others.

Researchers included 72 fluciclovine-PET scans performed at the University of Alabama at Birmingham (UAB) Hospital from January 2017 through June 2018 in their study. They set out to determine patient demographic and referral patterns for fluciclovine-PET/CT and PET/MRI at their institution.

Samuel J. Galgano, MD, with UAB’s Department of Radiology, and colleagues found the volume of [18F]fluciclovine- PET exams at their institution to be continually increasing, performing at least one study per week. A majority of patients were adult men older than 65, “as expected,” the authors wrote. A total of 69 percent were white, with 11 percent of imaging performed on black patients; “out of proportion” with the 76 percent white and 16 percent black makeup for all PET exams.

That low percentage also fell below the 32 percent of black patients who receive multiparametric prostate MRI and 29 percent who undergo MRI/US fusion biopsy at UAB.

“This leads to the question of whether there are racial disparities in utilization or simply early adoption of this advanced oncologic PET imaging technology, which deserves further study in a larger population,” Galgano et al. wrote.

Additionally, the researchers were not surprised to find urologists as the most frequent referring clinicians for fluciclovine-PET exams, followed by medical oncologists. If the modality will be utilized in the oncology setting for disease response and progression similar to that of fluorine-18-2fluoro-2-deoxy-D glucose PET exams, the authors wrote, they expect to see continuing growth for fluciclovine-PET exams.

“Radiation oncologists stand to benefit from fluciclovine-PET examinations by establishing eligibility for salvage or image-targeted stereotactic radiation therapy and for potentially improved delineation of tumor volumes and boundaries for contouring of radiation treatment planning,” the researchers wrote.

In patients with private insurance, the authors have noticed difficulty in receiving precertification for the exam, although it has received FDA approval in a biochemically recurrent prostate cancer setting posttreatment. And while a majority of patients who undergo [18F]fluciclovine-PET exams at UAB are covered by Medicare, some with private insurance have been forced to pay out-of-pocket for the exam.

Despite its single-institution limitations, Galgano et al. believe “this article is an early stepping stone for further research into utilization and disparities in fluciclovine-PET utilization."