Impact of 18 F-Fluciclovine PET/CT Findings on Failure-Free Survival in Biochemical Recurrence of Prostate Cancer Following Salvage Radiation Therapy.

We aimed to evaluate the impact of 18 F-fluciclovine PET/CT imaging on failure-free survival (FFS) post-salvage radiotherapy (SRT) for prostate cancer (PCa) recurrence. Seventy-nine patients were recruited in a phase 2/3 clinical trial to undergo 18 F-fluciclovine PET/CT before SRT for PCa. Four patients with extrapelvic disease were excluded. All patients were followed up at regular intervals up to 48 months. Treatment failure was defined as a serum prostate-specific antigen level of ≥0.2 ng/mL above the nadir after SRT, confirmed with an additional measurement, requiring systemic treatment or clinical progression. Failure-free survival was computed and compared between patients grouped according to 18 F-fluciclovine PET/CT imaging findings. Eighty percent (60/75) of patients had a positive finding on 18 F-fluciclovine PET/CT, of which 56.7% (34/60) had prostate bed-only uptake, whereas 43.3% (26/60) had pelvic nodal ± bed uptake. Following SRT, disease failure was detected in 36% (27/75) of patients. There was a significant difference in FFS between patients who had a positive versus negative scan (62.3% vs 92.9% [ P < 0.001] at 36 months and 59.4% vs 92.9% [ P < 0.001] at 48 months). Similarly, there was a significant difference in FFS between patients with uptake in pelvic nodes ± bed versus prostate bed only at 36 months (49.8% vs 70.7%; P = 0.003) and at 48 months (49.8% vs 65.6%; P = 0.040). Failure-free survival was also significantly higher in patients with either negative PET/CT or prostate bed-only disease versus those with pelvic nodal ± prostate bed disease at 36 (78% vs 49.8%, P < 0.001) and 48 months (74.4% vs 49.8%, P < 0.001). Findings on pre-SRT 18 F-fluciclovine PET/CT imaging, even when acted upon to optimize the treatment decisions and treatment planning, are predictive of post-SRT FFS in men who experience PCa recurrence after radical prostatectomy. A negative 18 F-fluciclovine PET/CT is most predictive of a lower risk of failure, whereas the presence of pelvic nodal recurrence portends a higher risk of SRT failure.

Informations de copyright

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of interest and sources of funding: A.B.J. reports personal fees from Blue Earth Diagnostics for advisory board services outside the submitted work. M.G. is entitled to a royalty derived from sale of products related to the research described in this report. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict of interest policies. The research consent forms state that he is entitled to a share of sales royalty received by Emory University from Nihon MediPhysics under that agreement. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict of interest policies. D.M.S. participates through the Emory University Office of Sponsored Projects in sponsored grants including those funded or partially funded by Blue Earth Diagnostics, Nihon MediPhysics, Telix Pharmaceuticals (US), Advanced Accelerator Applications, FUJIFILM Pharmaceuticals USA, and Amgen. D.M.S. also reports consultant fees outside the submitted work from Syncona, AIM Specialty Health, Global Medical Solutions Taiwan, and Progenics Pharmaceuticals. The other authors declare no competing interests. The EMPIRE-1 trial received funding from the National Institutes of Health/National Cancer Institute (R01 CA16918), Blue Earth Diagnostics, Ltd, and the Winship Cancer Institute of Emory University.