Effect of hormonal therapy on 18F-fluciclovine PET/CT in the detection of prostate cancer recurrence, localization of metastatic disease, and correlation with prostate-specific antigen

• Published in: Urologic oncology 2022-08, Vol.40 (8), p.379-379.e16
• Main Authors: Bulbul, Jad El, Hashem, Abdulrahman, Grybowski, Damian, Joyce, Cara, Rashad, Essam, Gabriel, Medhat S., Wagner, Robert H., Savir-Baruch, Bital
• Format: Article
• Language: English
• Subjects: 18F-fluciclovine; Androgen-deprivation; Biochemical recurrence; Hormonal therapy; Positron emission tomography; Prostatic neoplasms
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2022.05.018

•This retrospective study compared 18F-fluciclovine positron emission tomography/Computed tomography (PET/CT) positivity in patients with recurrent prostate cancer receiving androgen deprivation therapy (ADT) (n = 68) vs. those who were not (n = 252).•No significant difference in overall positivity rates were observed between the two groups, nor those for the prostate/bed and extraprostatic regions (P > 0.05).•Detection of prostate cancer recurrence with 18F-fluciclovine is not significant. influenced by ADT; it should not be necessary to withdraw patients from ADT before scanning with 18F-fluciclovine. 18F-Fluciclovine, is a positron emission tomography (PET) radiotracer approved for the localization of sites of prostate cancer recurrence in men with a rising prostate-specific antigen (PSA) after definitive treatment. To explore the impact of androgen deprivation therapy (ADT) on the performance of 18F-fluciclovine, we conducted a retrospective analysis to compare the 18F-fluciclovine PET/CT positivity rate in patients receiving ADT at the time of the scan with the rate achieved in patients not receiving ADT. A retrospective review of data from patients who underwent 18F-fluciclovine PET/CT for biochemical recurrence of prostate cancer between December 2016 to March 2020 was performed. The cohort was divided into an ADT group (patient reportedly on ADT) and a non-ADT group (not currently receiving ADT). Patients with unknown ADT status or undetectable/unknown PSA were excluded. For each group, the number of positive 18F-fluciclovine PET/CT scans (positivity rate) was evaluated for the whole body, prostate/bed, and extraprostatic regions and rates were correlated with PSA. The Fisher's Exact test was applied to establish the significance between the ADT and non-ADT positivity groups. Mantel-Haenszel trend test was performed to assess linearity between the positivity rate and PSA level. In 320 patients, the status of ADT was known. At the time of the 18F-fluciclovine scan, 68/320 (21%) patients were on ADT, while 252/320 (79%) were not. The median Gleason score was 8 (range of 6–10) in the ADT group vs. 7 (range of 6–10) in the non-ADT group (P < 0.001). Overall, positivity rates demonstrated no statistical significance between the ADT and non-ADT groups; Positivity rates (ADT vs. non-ADT) were 82% (56/68) vs. 82% (206/252) for the whole body, 57% (39/68) vs. 60% (152/252) for prostate/bed, and 60% (41/68) vs. 53% (133/252) for extraprostatic regions (P > 0