Review of 18F-Fluciclovine PET for Detection of Recurrent Prostate Cancer

Published Online:https://doi.org/10.1148/rg.2019180139

Fluorine 18 fluciclovine, a radiotracer that may be relatively new to readers, is described, and a case-based primer on the use of this agent is provided.

Fluorine 18 (18F) fluciclovine (anti-1-amino-3–18F-fluorocyclobutane-1-carboxylic acid [FACBC]) is a radiolabeled amino acid analog that takes advantage of the amino acid transport upregulation in several types of cancer cells. FACBC is taken up to a greater extent in prostate cancer cells than in surrounding normal tissue, providing an opportunity for its use in cases of this common cancer. In 2016, the U.S. Food and Drug Administration found the accuracy of FACBC PET to be superior to that of other molecular imaging techniques and subsequently granted approval for its use in PET of recurrent prostate cancer. As FACBC is an 18F radiotracer, an on-site cyclotron is not required for its production. This feature enables the widespread clinical availability of this agent and, in turn, an opportunity for improved patient care. The clinical pharmacology and imaging features of FACBC are reviewed, and the role of this agent in the imaging of recurrent prostate cancer, within the context of research that supports its effectiveness, is discussed. The administration of and image acquisition facilitated by using FACBC, as compared with 18F fluorodeoxyglucose, which is more widely used, are described. In addition, the criteria for interpreting FACBC imaging findings are outlined, with emphasis on common causes of false-positive and false-negative findings.

©RSNA, 2019

References

  • 1. Cancer facts & figures 2017. American Cancer Society website. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2017.html. Accessed January 26, 2018. Google Scholar
  • 2. Stephenson AJ, Scardino PT, Eastham JA, et al. Postoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Clin Oncol 2005;23(28):7005–7012. Crossref, MedlineGoogle Scholar
  • 3. Axumin (fluciclovine F 18) injection. U.S. Food and Drug Administration website. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2016/208054Orig1s000TOC.cfm. Accessed January 28, 2018. Google Scholar
  • 4. Wallitt KL, Khan SR, Dubash S, Tam HH, Khan S, Barwick TD. Clinical PET imaging in prostate cancer. RadioGraphics 2017;37(5):1512–1536. LinkGoogle Scholar
  • 5. Latorzeff I, Sargos P, Loos G, Supiot S, Guerif S, Carrie C. Delineation of the prostate bed: the “invisible target” is still an issue? Front Oncol 2017;7:108. Crossref, MedlineGoogle Scholar
  • 6. Thompson IM, Valicenti RK, Albertsen P, et al. Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO guideline. J Urol 2013;190(2):441–449. Crossref, MedlineGoogle Scholar
  • 7. Akin-Akintayo OO, Jani AB, Odewole O, et al. Change in salvage radiotherapy management based on guidance with FACBC (fluciclovine) PET/CT in postprostatectomy recurrent prostate cancer. Clin Nucl Med 2017;42(1):e22–e28. Crossref, MedlineGoogle Scholar
  • 8. Fuchs BC, Bode BP. Amino acid transporters ASCT2 and LAT1 in cancer: partners in crime? Semin Cancer Biol 2005;15(4):254–266. Crossref, MedlineGoogle Scholar
  • 9. Sakata T, Ferdous G, Tsuruta T, et al. L-type amino-acid transporter 1 as a novel biomarker for high-grade malignancy in prostate cancer. Pathol Int 2009;59(1):7–18. Crossref, MedlineGoogle Scholar
  • 10. Ono M, Oka S, Okudaira H, et al. [(14)C]fluciclovine (alias anti-[(14)C]FACBC) uptake and ASCT2 expression in castration-resistant prostate cancer cells. Nucl Med Biol 2015;42(11):887–892. Crossref, MedlineGoogle Scholar
  • 11. Schuster DM, Nanni C, Fanti S, et al. Anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid: physiologic uptake patterns, incidental findings, and variants that may simulate disease. J Nucl Med 2014;55(12):1986–1992. Crossref, MedlineGoogle Scholar
  • 12. Axumin full prescribing information. Axumin.com website. https://www.axumin.com/sites/default/files/2018-03/Axumin_PI_08_2016_Clean.pdf. Accessed February 2, 2018. Google Scholar
  • 13. Schuster DM, Nieh PT, Jani AB, et al. Anti-3-[(18)F]FACBC positron emission tomography-computerized tomography and (111)In-capromab pendetide single photon emission computerized tomography-computerized tomography for recurrent prostate carcinoma: results of a prospective clinical trial. J Urol 2014;191(5):1446–1453. Crossref, MedlineGoogle Scholar
  • 14. Nanni C, Schiavina R, Brunocilla E, et al. 18F-fluciclovine PET/CT for the detection of prostate cancer relapse: a comparison to 11C-choline PET/CT. Clin Nucl Med 2015;40(8):e386–e391. Crossref, MedlineGoogle Scholar
  • 15. Center for Drug Evaluation and Research application number: 208054Orig1s000 medical review(s). Center for Drug Evaluation and Research website. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2016/208054Orig1s000MedR.pdf. Accessed March 30, 2018. Google Scholar
  • 16. Odewole OA, Tade FI, Nieh PT, et al. Recurrent prostate cancer detection with anti-3-[(18)F]FACBC PET/CT: comparison with CT. Eur J Nucl Med Mol Imaging 2016;43(10):1773–1783. Crossref, MedlineGoogle Scholar
  • 17. Teoh E, Bottomley D, Scarsbrook A, et al. Impact of 18F-fluciclovine PET/CT on clinical management of patients with recurrent prostate cancer: results from the Phase 3 FALCON Trial. Int J Radiat Oncol Biol Phys 2017;99(5):1316–1317. CrossrefGoogle Scholar
  • 18. Calais J, Czernin J, Cao M, et al. 68Ga-PSMA-11 PET/CT mapping of prostate cancer biochemical recurrence after radical prostatectomy in 270 patients with a PSA level of less than 1.0 ng/mL: impact on salvage radiotherapy planning. J Nucl Med 2018;59(2):230–237. Crossref, MedlineGoogle Scholar
  • 19. Calais J, Fendler WP, Herrmann K, Eiber M, Ceci F. Head-to-head comparison of 68Ga-PSMA-11 PET/CT and 18F-fluciclovine PET/CT in a case series of 10 patients with prostate cancer recurrence. J Nucl Med 2018;59(5):789-794. Crossref, MedlineGoogle Scholar
  • 20. Oka S, Kanagawa M, Doi Y, Schuster DM, Goodman MM, Yoshimura H. Fasting enhances the contrast of bone metastatic lesions in 18F-fluciclovine-PET: preclinical study using a rat model of mixed osteolytic/osteoblastic bone metastases. Int J Mol Sci 2017;18(5):934. CrossrefGoogle Scholar
  • 21. Savir-Baruch B, Zanoni L, Schuster DM. Imaging of prostate cancer using fluciclovine. PET Clin 2017;12(2):145–157. Crossref, MedlineGoogle Scholar
  • 22. Schuster DM. Imaging prostate cancer with fluciclovine: practical approach [abstr]. In: Radiological Society of North America scientific assembly and annual meeting program. Oak Brook, Ill: Radiological Society of North America, 2017. Google Scholar
  • 23. Schuster DM, Nye JA, Nieh PT, et al. Initial experience with the radiotracer anti-1-amino-3-[18F]fluorocyclobutane-1-carboxylic acid (anti-[18F]FACBC) with PET in renal carcinoma. Mol Imaging Biol 2009;11(6):434–438. Crossref, MedlineGoogle Scholar
  • 24. Tsuyuguchi N, Terakawa Y, Uda T, Nakajo K, Kanemura Y. Diagnosis of brain tumors using amino acid transport PET imaging with 18F-fluciclovine: a comparative study with L-methyl-11C-methionine PET imaging. Asia Ocean J Nucl Med Biol 2017;5(2):85–94. MedlineGoogle Scholar
  • 25. Amzat R, Taleghani P, Miller DL, et al. Pilot study of the utility of the synthetic PET amino-acid radiotracer anti-1-amino-3-[18F]fluorocyclobutane-1-carboxylic acid for the noninvasive imaging of pulmonary lesions. Mol Imaging Biol 2013;15(5):633–643. Crossref, MedlineGoogle Scholar
  • 26. Ahn D, Yeo CK, Han SY, Kim JK. The accessory parotid gland and facial process of the parotid gland on computed tomography. PLoS One 2017;12(9):e0184633. Crossref, MedlineGoogle Scholar
  • 27. Jambor I, Kuisma A, Kähkönen E, et al. Prospective evaluation of 18F-FACBC PET/CT and PET/MRI versus multiparametric MRI in intermediate- to high-risk prostate cancer patients (FLUCIPRO trial). Eur J Nucl Med Mol Imaging 2018;45(3):355–364. Crossref, MedlineGoogle Scholar
  • 28. Zarzour JG, Galgano S, McConathy J, Thomas JV, Rais-Bahrami S. Lymph node imaging in initial staging of prostate cancer: an overview and update. World J Radiol 2017;9(10):389–399. Crossref, MedlineGoogle Scholar
  • 29. Incerti E, Mapelli P, Gianolli L, Picchio M. PET imaging for lymph node dissection in prostate cancer. World J Urol 2017;35(4):507–515. Crossref, MedlineGoogle Scholar
  • 30. Qi Y, Liu X, Li J, Yao H, Yuan S. Fluorine-18 labeled amino acids for tumor PET/CT imaging. Oncotarget 2017;8(36):60581–60588. Crossref, MedlineGoogle Scholar
  • 31. Kondo A, Ishii H, Aoki S, et al. Phase IIa clinical study of [18F]fluciclovine: efficacy and safety of a new PET tracer for brain tumors. Ann Nucl Med 2016;30(9):608–618. Crossref, MedlineGoogle Scholar
  • 32. Tade FI, Cohen MA, Styblo TM, et al. Anti-3-18F-FACBC (18F-fluciclovine) PET/CT of breast cancer: an exploratory study. J Nucl Med 2016;57(9):1357–1363. Crossref, MedlineGoogle Scholar
  • 33. Ulaner GA, Goldman DA, Gönen M, et al. Initial results of a prospective clinical trial of 18F-fluciclovine PET/CT in newly diagnosed invasive ductal and invasive lobular breast cancers. J Nucl Med 2016;57(9):1350–1356. Crossref, MedlineGoogle Scholar

Article History

Received: Apr 6 2018
Revision requested: May 30 2018
Revision received: June 23 2018
Accepted: July 13 2018
Published online: May 06 2019
Published in print: May 2019