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Nuclear Medicine

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

Published Online:May 6 2019https://doi.org/10.1148/rg.2019180139

Abstract

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

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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