Feasibility and Initial Results: Fluciclovine PET/Ultrasound Fusion Targeted Biopsy of Recurrent Prostate Cancer.

To assess the feasibility and cancer detection rate of fluciclovine (18F) positron emission tomography (PET) ultrasound fusion targeted biopsy versus standard template biopsy in the same patient with biochemical failure after non-surgical therapy for prostate cancer.

21 patients (mean PSA 7.4±6.8) with biochemical failure after non-surgical prostate cancer treatment underwent fluciclovine (18F) PET-CT (364.1±37.7 MBq) and a planning transrectal prostate ultrasound with 3-D image reconstruction. Focal prostatic activity on PET were delineated and co-registered with planning ultrasound. During the subsequent biopsy session, computer-generated 12-core template biopsies were performed, and then fluciclovine defined targets were revealed and biopsied. Histologic analysis of template and targeted cores were completed.

Template biopsy was positive for malignancy in 6/21 (28.6%) patients (10/124 regions; 11/246 cores) versus targeted biopsy in 10/21 (47.6%) patients (17/50 regions; 40/125 cores). 5/21 patients were positive on targeted biopsy only and 1/21 patients were positive on template biopsy only. One additional patient was upgraded from Grade Group 2 to 3 on targeted biopsy. Extraprostatic disease was detected in 8/21 (38.1%) patients with histologic confirmation in 3/3 patients who underwent lesion biopsy.

Fluciclovine PET real-time ultrasound fusion guidance for biopsy in post-non-prostatectomy patients with biochemical failure is feasible and identifies more recurrent prostate cancer with 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 for recurrent prostate cancer.

The Journal of urology. 2019 Feb 28 [Epub ahead of print]

Baowei Fei, Olayinka A Abiodun-Ojo, Akinyemi A Akintayo, Oladunni Akin-Akintayo, Funmilayo Tade, Peter T Nieh, Viraj A Master, Mehrdad Alemozaffar, Adeboye O Osunkoya, Mark M Goodman, David M Schuster

Department of Radiology and Imaging Sciences, Emory University School of Medicine , Atlanta , GA., Department of Radiology, Loyola University , Chicago , IL., Department of Urology, Emory University School of Medicine , Atlanta , GA.