TY - JOUR
T1 - 18F-Fluciclovine Positron Emission Tomography in Men With Biochemical Recurrence of Prostate Cancer After Radical Prostatectomy and Planning to Undergo Salvage Radiation Therapy
T2 - Results from LOCATE
AU - LOCATE Study Group
AU - Solanki, Abhishek A.
AU - Savir-Baruch, Bital
AU - Liauw, Stanley L.
AU - Michalski, Jeff
AU - Tward, Jonathan D.
AU - Vapiwala, Neha
AU - Teoh, Eugene J.
AU - Adler, Lee P.
AU - Andriole, Gerald L.
AU - Belkoff, Laurence H.
AU - Burzon, Daniel
AU - Chau, Albert
AU - Dato, Paul
AU - Duan, Fenghai
AU - Farwell, Michael
AU - Fogelson, Stephen
AU - Gardiner, Peter
AU - Hanna, Lucy
AU - Hoffman, John M.
AU - Intenzo, Charles
AU - Josephson, David
AU - Kaminetsky, Jed
AU - Kipper, Michael
AU - Kostakoglu, Lale
AU - Krynyckyi, Borys
AU - Linder, Karen E.
AU - Mahmood, Umar
AU - Marques, Helga
AU - Mankoff, David
AU - McConathy, Jonathan
AU - Melnick, John
AU - Miller, Matthew P.
AU - Oh, William
AU - Philips, Shaile
AU - Rose, Judith
AU - Schuster, David M.
AU - Siegel, Barry A.
AU - Stevens, Daniel J.
AU - Tewari, Ashutosh
AU - Twardowski, Przemyslaw
AU - Ward, Penelope
AU - Wasserman, Martha
AU - Weick, Sharon
AU - (Michael) Yu, Jian Q.
N1 - Funding Information:
Sources of support: This study was supported by Blue Earth Diagnostics, Oxford, UK. Disclosures: Dr Solanki has received personal fees from Varian Medical Systems and Novocure plus grants and personal fees from Blue Earth Diagnostics, all outside the submitted work. Dr Savir-Baruch has received grants from Blue Earth Diagnostics during the conduct of the study and outside the submitted work. Dr Michalski has received personal fees from Blue Earth Diagnostics, outside the submitted work. Dr Tward has received personal fees from Blue Earth Diagnostics, Merck, Janssen, GenomeDX, and Astellas, grants and personal fees from Bayer and Myriad Genetics, and currently has a consulting agreement with Augmenix, all outside the submitted work. Dr Teoh is an employee of Blue Earth Diagnostics, Ltd. All other authors have no disclosures to declare.
Funding Information:
Sources of support: This study was supported by Blue Earth Diagnostics , Oxford, UK.
Publisher Copyright:
© 2020
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Purpose: Conventional imaging rarely localizes the site(s) of prostate cancer recurrence in patients undergoing evaluation for salvage radiation therapy (sRT) after radical prostatectomy (RP). LOCATE (NCT02680041) was a prospective, multicenter study investigating the impact of 18F-fluciclovine positron emission tomography and computed tomography (PET/CT) on the management of patients with biochemical recurrence of prostate cancer after curative-intent radiation or RP and negative or equivocal conventional imaging. Our objective was to determine the impact of 18F-fluciclovine PET/CT on treatment decisions for men planning to undergo sRT for biochemical recurrence post-RP. Methods and Materials: We conducted a subgroup analysis of post-RP patients enrolled in LOCATE who were planning to undergo sRT with or without hormonal therapy based on prescan documentation. 18F-Fluciclovine PET/CT was performed according to standardized procedures. The treatment plan postscan was compared with the prescan plan, and Fisher exact test was used to determine the impact of prescan prostate-specific antigen (PSA) and Gleason sum (GS) on positivity and anatomic patterns of uptake. Results: A total of 114 patients (median prescan PSA 0.42 [interquartile range, 0.3-1.1] ng/mL) met selection criteria (54% of patients in LOCATE). Forty-eight (42%) had 18F-fluciclovine-avid lesions. Twelve patients (11%) had positive findings only in the prostate bed, 24 (21%) had positivity only in the pelvis (prostate bed or pelvic nodes), and 24 (21%) had extrapelvic findings. PSA >0.5 ng/mL and GS ≥8 were associated with a higher risk of extrapelvic positivity (P < .05). Postscan, 55 (48%) patients had a management change; 37 (32%) had a change in overall treatment approach (ie, omission of sRT); and 18 (16%) had sRT target modification. Conclusions: 18F-Fluciclovine PET/CT is positive in nearly half of patients planning to undergo post-RP sRT with negative/equivocal conventional imaging, with findings frequently leading to changes in management. PSA >0.5 ng/mL and GS ≥8 are associated with a higher risk of extrapelvic positive findings.
AB - Purpose: Conventional imaging rarely localizes the site(s) of prostate cancer recurrence in patients undergoing evaluation for salvage radiation therapy (sRT) after radical prostatectomy (RP). LOCATE (NCT02680041) was a prospective, multicenter study investigating the impact of 18F-fluciclovine positron emission tomography and computed tomography (PET/CT) on the management of patients with biochemical recurrence of prostate cancer after curative-intent radiation or RP and negative or equivocal conventional imaging. Our objective was to determine the impact of 18F-fluciclovine PET/CT on treatment decisions for men planning to undergo sRT for biochemical recurrence post-RP. Methods and Materials: We conducted a subgroup analysis of post-RP patients enrolled in LOCATE who were planning to undergo sRT with or without hormonal therapy based on prescan documentation. 18F-Fluciclovine PET/CT was performed according to standardized procedures. The treatment plan postscan was compared with the prescan plan, and Fisher exact test was used to determine the impact of prescan prostate-specific antigen (PSA) and Gleason sum (GS) on positivity and anatomic patterns of uptake. Results: A total of 114 patients (median prescan PSA 0.42 [interquartile range, 0.3-1.1] ng/mL) met selection criteria (54% of patients in LOCATE). Forty-eight (42%) had 18F-fluciclovine-avid lesions. Twelve patients (11%) had positive findings only in the prostate bed, 24 (21%) had positivity only in the pelvis (prostate bed or pelvic nodes), and 24 (21%) had extrapelvic findings. PSA >0.5 ng/mL and GS ≥8 were associated with a higher risk of extrapelvic positivity (P < .05). Postscan, 55 (48%) patients had a management change; 37 (32%) had a change in overall treatment approach (ie, omission of sRT); and 18 (16%) had sRT target modification. Conclusions: 18F-Fluciclovine PET/CT is positive in nearly half of patients planning to undergo post-RP sRT with negative/equivocal conventional imaging, with findings frequently leading to changes in management. PSA >0.5 ng/mL and GS ≥8 are associated with a higher risk of extrapelvic positive findings.
UR - http://www.scopus.com/inward/record.url?scp=85087958720&partnerID=8YFLogxK
U2 - 10.1016/j.prro.2020.05.007
DO - 10.1016/j.prro.2020.05.007
M3 - Article
C2 - 32464368
AN - SCOPUS:85087958720
SN - 1879-8500
VL - 10
SP - 354
EP - 362
JO - Practical Radiation Oncology
JF - Practical Radiation Oncology
IS - 5
ER -