The positron emission tomography (PET) radiotracer fluciclovine (fluorine-18; F-18) can be used to monitor and guide treatment of patients with recurrent prostate cancer.1
“This is the first study of its kind demonstrating changes in postsurgery radiotherapy target design with advanced molecular imaging in recurrent prostate cancer, with no demonstrated increase in early radiotherapy side effects,” explains Ashesh B. Jani, MD, of the Winship Cancer Institute of Emory University, and lead researcher of a recent study published in the Journal of Nuclear Medicine.
The clinical trial included 96 patients with recurrent prostate cancer after prostatectomy. All patients received initial treatment planning using conventional abdominopelvic imaging (CT or MRI). Forty-five patients underwent an additional abdominopelvic F-18-fluciclovine PET/CT, which better defined the tumor target area leading to modification of the previous treatment plan.
The inclusion of F-18-fluciclovine PET information in treatment planning led to significant differences in the areas to receive radiotherapy. Higher doses were observed in the penile bulb, but no significant differences in bladder or rectal radiation or in acute genitourinary or gastrointestinal toxicity were observed.
This is the first set of results from a 3-year long study, where investigators expect to observe an increase in disease-free survival for patients who received F-18-fluciclovine PET with subsequent treatment modification, compared with those who did not receive treatment modification informed by F-18-fluciclovine PET.
F-18-fluciclovine PET helps doctors to detect and localize prostate cancer allowing for individualized, targeted therapy and could have broader implications. According to Jani, “Our methodology is readily applicable to other novel imaging agents, and it may potentially facilitate improvement of cancer control outcomes.”
1. Jani AB, Schreibmann E, Rossi PJ, et al. Impact of 18F-fluciclovine PET on target volume definition for postprostatectomy salvage radiotherapy: initial findings from a randomized trial. J Nucl Med. 2017;58(3):412-418. doi: 10.2967/jnumed.116.176057