The utility of [18F]Fluciclovine PET/CT in Evaluating Nonmetastatic Castrate Resistant Prostate Cancer Patients (nmCRPCp): Diagnostic performance and Impact on Management.

To evaluate the role of [18F]Fluciclovine PET/CT scan in restaging nmCRPCp and its impact on management.

This retrospective study included all patients with nonmetastatic castrate-resistant prostate cancer, who underwent [18F]Fluciclovine PET/CT scans for restaging who had concern for disease progression. Two radiologists independently reviewed the PET/CT studies, assigned an overall impression, and reported the site and number of radiotracer activities in consensus and impact on management was recorded. Available tissue diagnosis and/or six-month clinical and imaging follow-up were used as reference standards.

35 patients were included in this study. At least one lesion was detected in 73% (26/35) of the scans. Management changed in 71% (25/35) of patients, (22 positives and three negative scans). 26.9% (7/26) of patients were found to have an oligometastatic disease. Based on the reference standards, the diagnostic performance of [18F]Fluciclovine PET/CT in detecting recurrence in nmCRCP has 86%, sensitivity, 83% specificity, 96.1% PPV, and 55.5% NPV. There was no relationship between the Gleason score and a positive PET/CT scan in our patient population.

Detecting the source of recurrence is challenging in nmCRCP patients when conventional imaging fails. Given the high PPV, sensitivity, and specificity, [18F]Fluciclovine PET/CT can be used instead of conventional imaging as a first-line choice due to its superiority over bone scan and added value of detecting soft tissue metastasis regardless of the initial Gleason score.

The study highlights the added value of [18F]Fluciclovine PET/CT in detecting soft tissue metastasis regardless of the initial Gleason score, which is not possible with conventional imaging such as bone scans.The study highlights the potential role of [18F]Fluciclovine PET/CT guiding management change for nonmetastatic castrate-resistant prostate cancer patients, particularly those with oligometastatic disease.

The British journal of radiology. 2023 Sep 26 [Epub ahead of print]

Moataz Soliman, Kareem Elfatairy, Reham Mohammed Ibrahim Ellessy, Yury S Velichko, Ryan Avery, Linda C Kelahan, Ashley E Ross, Hatice Savas

Department of Radiology, Northwestern University, Chicago, IL, USA., Department of Radiology, Bridgeport Hospital, Yale New Haven, CT, USA., Department of Radiology, Cairo University, Cairo, Egypt., Department of Urology, Northwestern University, Chicago, IL, USA.