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 - 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 -