Presentation Authors: Gerald Andriole*, Barry Siegel, Saint Louis, MO, . LOCATE Study Group, x, WA
Introduction: Early and precise localization of lesions in men with recurrent prostate cancer facilitates treatment when tumors are small and amenable to localized therapy and may guide salvage therapy decisions. 18F-Fluciclovine is approved for use in Europe and the USA for localization of metastases in patients with suspected recurrence of prostate cancer by positron emission tomography (PET). The prospective LOCATE trial assessed the impact of 18F-fluciclovine PET/CT on the management of men with PSA-recurrence after curative intent primary therapy and negative/equivocal standard imaging. Here, we use data from LOCATE to evaluate the detection rate (DR) of 18F-fluciclovine PET/CT in men with prostate cancer recurrence with or without radical prostatectomy (RP).
Methods: Eligible men (â‰¥ 18 y; prior curative intent treatment of prostate cancer; recurrence based on rising PSA; negative/equivocal findings on conventional imaging) underwent 18F-fluciclovine PET/CT according to standard protocol at one of 15 US centers. Scan findings were stratified according to patients&[prime] prior therapy and baseline characteristics.
Results: Between June 2016 and May 2017, 213 evaluable patients (median PSA = 1.00 ng/mL; median 54 months post-initial diagnosis) were enrolled. In total, 164/213 (77%) men had RP prior to enrollment. The table shows baseline characteristics and the 18F-fluciclovine DR according to RP status. PSA levels ranged more widely among the prior RP group compared with the intact prostate group, although the intact prostate group had a higher median PSA. 18F-Fluciclovine-avid lesions were found in 122 (57%) men, with a DR of 49% (81/164) in men with prior RP and 84% (41/49) in the intact prostate group. The overall DR was broadly proportional to the pre-scan PSA and ranged from 31% among those with a PSA < 0.5 ng/mL to 95% among patients with a PSA > 10 ng/mL. In the prior prostatectomy group, the DR ranged from 31% at PSA < 0.5 ng/mL to 95% at PSA > 10 ng/mL.
Conclusions: In this cohort of men with PSA-recurrence but negative/equivocal standard imaging, the majority were shown to have one or more lesion by 18F-fluciclovine PET/CT. The DR increased with increasing PSA and was higher among patients with intact prostate than those who had previously undergone RP.
Source of Funding: Blue Earth Diagnostics