Fluciclovine PET/CT IDs recurrent prostate cancer, alters patient management

Adding fluorine-18 (18F)-fluciclovine PET/CT to the diagnostic treatment plan of patients with biochemical recurrence of prostate cancer can identify previously undetected lesions and alter treatment management for patients with the disease.

The study was presented at the Society of Nuclear Medicine and Molecular Imaging (SNMMI) annual meeting in Philadelphia.  

“Recurrent prostate cancer poses an important medical challenge,” said Austin R. Pantel, MD, of the University of Pennsylvania in Philadelphia, in a statement. “Currently approved anatomical imaging procedures have limitations in identifying the sites of recurrence of prostate cancer after definitive treatment. This can make decision-making difficult when assessing these patients.”

Some 213 men with biochemically recurrent prostate cancer underwent 18F-fluciclovine PET/CT following negative or ambiguous findings from traditional imaging (bone scan, CT or MRI). The prospective multicenter study—LOCATE trial—looked at the relationship between scan outcome and the clinical variable of recurrence site, practice setting, prostate-specific antigen (PSA) level and Gleason score. Physicians completed a questionnaire which documented changes in patient management following PET.

Results showed that 59 percent of patients had their clinical management changed after findings from (18F) PET/CT. Of that total, 78 percent were categorized as “major” or resulting in a change in modality.

Cancer was in the prostate, pelvic and abdominal lymph node tissue and bone. Positive and negative scans each affected patient management. However, there was no difference seen in the rate of positive scans or the rate of management changes between private practices and academic settings.

“While investigation of the long-term clinical outcomes of these changes in management is warranted, these results indicate, for the first time in a prospective U.S. study, that decisions based on 18F-fluciclovine PET/CT imaging may facilitate more appropriate management in men with biochemical recurrence of their prostate cancer, Pantel said. “The study also demonstrates the broad potential applicability of 18F-fluciclovine PET/CT imaging across a range of clinical settings.”