Accurate preoperative staging of prostate cancer (PCa) is essential for treatment planning. Conventional imaging (CI) is limited in detection of metastases. Our primary aim was to determine if [18F]fluciclovine PET/CT is an early indicator of sub-clinical metastasis among patients with high-risk PCa.
68 patients with unfavorable intermediate to very high-risk PCa without systemic disease on CI were recruited before robotic radical prostatectomy with extended pelvic lymph node dissection (EPLND). Diagnostic performance of [18F]fluciclovine PET/CT and CI for detection of metastatic disease, and correlation of positivity to node and metastatic deposit size were determined.
57/68 patients completed the protocol, of which 31/57 had nodal metastasis on histology. [18F]fluciclovine PET/CT sensitivity and specificity in detecting nodal metastasis were 55.3% and 84.8% per-patient, 54.8% and 96.4% per-region (right and left pelvis, presacral and non-regional), respectively. Compared with CI, [18F]fluciclovine PET/CT had significantly higher sensitivity on patient-based (55.3% vs 33.3%; p<0.01) and region-based (54.8% vs 19.4%; p<0.01) analysis, detecting metastasis in 7 more patients and 22 more regions; with similar high specificity. Four additional patients had distant disease or other cancer detected on [18F]fluciclovine PET/CT which precluded surgery. Detection of metastasis was related to size of metastatic deposits within LNs, and overall metastatic burden.
[18F]fluciclovine PET/CT detects occult metastases not identified on CI and may help guide treatment decisions and lymph node dissection due to high specificity for metastatic disease.
The Journal of urology. 2020 Apr 29 [Epub ahead of print]
Mehrdad Alemozaffar, Akinyemi A Akintayo, Olayinka A Abiodun-Ojo, Dattatraya Patil, Faisal Saeed, Yijian Huang, Adeboye O Osunkoya, Mark M Goodman, Martin Sanda, David M Schuster
Department of Urology, Emory University School of Medicine, Atlanta, Georgia., Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia., Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia., Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia.