Imaging with 18F-fluciclovine positron emission tomography/computed tomography identified sites of disease recurrence in a majority of prostate cancer patients with biochemical recurrence and led to changes in treatment course in 59% of men scanned, according to a recent study (J Urol Sept. 1, 2018 [epub ahead of print]).
Armed with information from 18F fluciclovine PET/CT (Axumin, Blue Earth Diagnostics), urologists and patients with suspected biochemical recurrence of prostate cancercould make more informed decisions about treatment. Researchers do not yet know if the information provided by the scan changes outcomes from treatment.
“The dilemma with biochemical recurrence is that urologists, radiation therapists, and medical oncologists have to make an educated guess as to where the recurrence is. We would use things like the quickness with which the PSA recurred after therapy, or the PSA velocity, to infer whether that recurrence is somewhere locally, in the prostate or prostatic bed, or distantly, meaning metastatic to lymph nodes or the bone. The problem is that kind of guesswork was frequently inaccurate,” said Gerald L. Andriole, MD, of Washington University School of Medicine in St. Louis and lead author of the LOCATE trial, a prospective, multi-center, open-label study done at 15 U.S. sites.
“Now we have this imaging study that can show us where the site of recurrence is in most patients. And that can allow us to do smarter, more targeted therapies,” Dr. Andriole said.
Dr. Andriole and co-authors studied use of 18F fluciclovine, an FDA-approved molecular imaging agent for use in PET imaging in men with suspected prostate cancer recurrence, in 213 patients thought to have biochemical recurrence. They found 18F fluciclovine PET/CT was positive in 57% of patients, leading to often-major changes in treatment for more than half of the patients studied. Among the changes, three-quarters of the 60 patients who were going to have androgen deprivation therapy (ADT)changed post-scan to non-systemic salvage treatment.
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