童綜合醫院 外科部 泌尿科
Could 18F-Fluciclovine PET/CT be a Game Changer in Prostate Cancer with Biochemical Recurrence?
Wei-Shiang Hu, Yi-Sheng Lin, Jow-Yu Hsu, Yen-Chuan Ou, Min-Che Tung
Division of Urology, Department of Surgery,
Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
18F-Fluciclovine PET/CT helps locate recurrence in men with biochemical recurrence (BCR) of prostate cancer, but it contributes a great financial burden to the patients. To date, 18F-Fluciclovine PET/CT is not covered by national health insurance (NHI) in Taiwan. We share the real-world experience in Taiwan how 18F-Fluciclovine PET/CT plays a role in men with BCR.
Materials and methods
We documented the patients who underwent 18F-Fluciclovine PET/CT due to either a BCR after radical prostatectomy or a BCR after salvage radiotherapy (SRT)/ androgen deprivation therapy (ADT), defined as two rises in prostate-specific antigen (PSA) of ≥0.2 ng/mL above nadir. The primary outcome is the timing to perform 8F-Fluciclovine PET/CT, including BCR-to-detection time (duration between the date of BCR and 18F-Fluciclovine PET/CT), the PSA level before detection and conventional images (CT or MRI) before detection. The secondary outcome is the image findings of 18F-Fluciclovine PET/CT and the revision of treatment plans based on 18F-Fluciclovine PET/CT.
18F-Fluciclovine PET/CT was performed in 22 patients. 12 patients experienced the first BCR after radical prostatectomy while 10 patients experienced the second BCR after SRT/ADT. The mean BCR-to-detection time was 4 months. The mean PSA level before detection was 5.29 ng/dL. 15(68.2%) patients underwent conventional images before detection. 18F-Fluciclovine-avid lesions were detected in 12 out of 22 (54.5%) patients, with detection rates of 27.3% in the prostate/bed and 45.5% in extraprostatic regions. After 18F-Fluciclovine PET/CT, treatment plans were revised for 11 out of 15 (73.3%) patients with conventional images.
Based on NHI in Taiwan, 18F-Fluciclovine PET/CT is majorly considered the second confirmation after NHI-covered conventional images rather than the first modality to investigate BCR of prostate cancer. Treatment plans according to conventional images may largely be revised after 18F-Fluciclovine PET/CT.