Detection Rate and Clinical Impact of PET/CT with 18F-FACBC in Patients with Biochemical Recurrence of Prostate Cancer: A Retrospective Bicentric Study

Our aim was to assess the detection rate (DR) of positron emission computed tomography (PET/CT) with anti-1-amino-3-[F-18]-flurocyclobutane-1-carboxylic acid (F-18-FACBC) in patients with biochemical recurrence (BCR) from prostate cancer (PC). As a secondary endpoint, we evaluated F-18-FACBC PET/CT's impact on patients management. Clinical records of 81 patients submitted to F-18-FACBC PET/CT due to PC BCR in two Italian Nuclear Medicine Units were retrospectively assessed. DR was gauged in the whole cohort and stratifying patients by discrete intervals of PSA levels. PET/CT's impact on clinical management was scored as (1) major if it entailed an intermodality change (e.g., from systemic to loco-regional therapy); (2) minor if it led to an intramodality change (e.g., modified radiotherapy field). PET/CT's DR resulted in 76.9% in the whole cohort, with a positive predictive value of 96.7%. Stratified by PSA quartile intervals, PET/CT's DR was 66.7%, 71.4%, 78.9% and 90% for PSA 0.2-0.57 ng/mL, 0.58-0.99 ng/mL, 1-1.5 ng/mL and >1.5 ng/mL without significant difference among groups (p = 0.81). The most common sites of relapse were prostate bed and pelvic lymph nodes (59.3%). PET/CT impacted on clinical management in 33/81 cases (40.7%), leading to a major change in 30 subjects (90.9%). F-18-FACBC PET/CT localized recurrence in patients with BCR, with meaningful DR also at low PSA levels and significantly impacted on clinical management.

Automated summary

The aim of this study was to evaluate the detection rate (DR) of F-18-FACBC PET/CT and its impact on the management of patients with biochemical recurrence from prostate cancer. The results showed that F-18-FACBC PET/CT had a DR of 76.9% in the entire cohort, with no significant difference among different PSA levels, and had a significant impact on clinical management.