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[18F]Fluciclovine PET/CT: joint EANM and SNMMI procedure guideline for prostate cancer imaging—version 1.0


The aim of this guideline is to provide standards for the recommendation, performance, interpretation, and reporting of [18F]Fluciclovine PET/CT for prostate cancer imaging. These recommendations will help to improve accuracy, precision, and repeatability of [18F]Fluciclovine PET/CT for prostate cancer essentially needed for implementation of this modality in science and routine clinical practice.

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Fig. 1


  1. 1.

    Savir-Baruch B, Zanoni L, Schuster DM. Imaging of prostate cancer using fluciclovine. Urol Clin North Am. 2018;45:489–502.

  2. 2.

    Washburn LC, Sun TT, Byrd B, Hayes RL, Butler TA. 1-aminocyclobutane[11C] carboxylic acid, a potential tumor-seeking agent. J Nucl Med. 1979;20:1055–61.

  3. 3.

    ShoupTM OJ, Hoffman JM, Votaw J, Eshima D, Eshima L, et al. Synthesis and evaluation of [18F]1-amino-3-fluorocyclobutane-1-carboxylic acid to image brain tumors. J Nucl Med. 1999;40:331–8.

  4. 4.

    Oka S, Hattori R, Kurosaki F, Toyama M, Williams LA, Yu W, et al. A preliminary study of anti-1-amino-3-18F-fluorocyclobutyl-1-carboxylic acid for the detection of prostate cancer. J Nucl Med. 2007;48:46–55.

  5. 5.

    Schuster DM, Votaw JR, Nieh PT, Yu W, Nye JA, Master V, et al. Initial experience with the radiotracer anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid with PET/CT in prostate carcinoma. J Nucl Med. 2007;48:56–63.

  6. 6.

    Evans JD, Jethwa KR, Ost P, Williams S, Kwon ED, Lowe VJ, et al. Prostate cancer-specific PET radiotracers: a review on the clinical utility in recurrent disease. PractRadiatOncol. 2018;8:28–39.

  7. 7.

    Okudaira H, Shikano N, Nishii R, Miyagi T, Yoshimoto M, Kobayashi M, et al. Putative transport mechanism and intracellular fate of trans-1-amino-3-18F-fluorocyclobutanecarboxylic acid in human prostate cancer. J Nucl Med. 2011;52:822–9.

  8. 8.

    Oka S, Okudaira H, Yoshida Y, Schuster DM, Goodman MM, Shirakami Y. Transport mechanisms of trans-1-amino-3-fluoro[1-14C]cyclobutanecarboxylic acid in prostate cancer cells. Nucl Med Biol. 2012;39:109–19.

  9. 9.

    Sun A, Liu X, Tang G. Carbon-11 and fluorine-18 labeled amino acid tracers for positron emission tomography imaging of tumors. Front Chem. 2018;5:124.

  10. 10.

    Wang Q, Hardie R-A, Hoy AJ, van Geldermalsen M, Gao D, Fazli L, et al. Targeting ASCT2-mediated glutamine uptake blocks prostate cancer growth and tumour development. J Pathol. 2015;236:278–89.

  11. 11.

    Xu M, Sakamoto S, Matsushima J, Kimura T, Ueda T, Mizokami A, et al. Up-regulation of LAT1 during antiandrogen therapy contributes to progression in prostate cancer cells. J Urol. 2016;195:1588–97.

  12. 12.

    Otsuki H, Kimura T, Yamaga T, Kosaka T, Suehiro J, Sakurai H. Prostate cancer cells in different androgen receptor status employ different leucine transporters. Prostate. 2017;77:222–33.

  13. 13.

    Fuchs BC, Bode BP. Amino acid transporters ASCT2 and LAT1 in cancer: partners in crime? Semin Cancer Biol. 2005;15:254–66.

  14. 14.

    Nicklin P, Bergman P, Zhang B, Triantafellow E, Wang H, Nyfeler B, et al. Bidirectional transport of amino acids regulates mTOR and autophagy. Cell. 2009;136:521–34.

  15. 15.

    Goberdhan DCI, Wilson C, Harris AL. Amino acid sensing by mTORC1: intracellular transporters mark the spot. Cell Metab. 2016;23:580–9.

  16. 16.

    Okudaira H, Oka S, Ono M, Nakanishi T, Schuster DM, Kobayashi M, et al. Accumulation of of trans-1-amino-3-[18F]fluorocyclobutanecarboxylic acid in prostate cancer due to androgen-induced expression on amino acid transporters. Mol Imaging Biol. 2014;16:756–64.

  17. 17.

    Ono M, Oka S, Okudaira H, Nakanishi T, Mizokami A, Kobayashi M, et al. [14C]fluciclovine (alias anti-[14C]FACBC) uptake and ASCT2 expression in castration resistant prostate cancer cells. Nucl Med Biol. 2015;42:887–92.

  18. 18.

    Boellaard R, Delgado-Bolton R, Oyen WJ, Giammarile F, Tatsch K, Eschner W, et al. FDGPET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54.

  19. 19.

    Cookson MS, Aus G, Burnett AL, et al. Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes. J Urol. 2007;177:540–5.

  20. 20.

    Roach M 3rd, Hanks G, Thames H Jr, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys. 2006;65:965–74.

  21. 21.

    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:e22–8.

  22. 22.

    Kairemo K, Rasulova N, Partanen K, Joensuu T. Preliminary clinical experience of trans-1-Amino-3-(18)F-fluorocyclobutanecarboxylic acid (anti-(18)F-FACBC) PET/CT imaging in prostate cancer patients. Biomed Res Int. 2014;2014:305182.

  23. 23.

    Bach-Gansmo T, Nanni C, Nieh PT, et al. Multisite experience of the safety, detection rate and diagnostic performance of [18F]Fluciclovine positron emission tomography/computerized tomography imaging in the staging of biochemically recurrent prostate cancer. J Urol. 2017;197:676–83.

  24. 24.

    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;191:1446–53.

  25. 25.

    Nanni C, Zanoni L, Pultrone C, et al. (18)F-FACBC (anti1-amino-3-(18)F-fluorocyclobutane-1-carboxylic acid) versus (11)C-choline PET/CT in prostate cancer relapse: results of a prospective trial. Eur J Nucl Med Mol Imaging. 2016;43:1601–10.

  26. 26.

    Oka S, Kanagawa M, Doi Y, Schuster DM, Goodman MM, Yoshimura H. PET tracer 18F-Fluciclovine can detect histologically proven bone metastatic lesions: a preclinical study in rat osteolytic and osteoblastic bone metastasis models. Theranostics. 2017;7:2048–64.

  27. 27.

    Chau A, Gardiner P, Colletti PM, Jadvar H. Clin Nucl Med. 2018;43(7):e226–31.

  28. 28.

    Geinitz H, et al. Outcome after conformal salvage radiotherapy in patients with rising prostate-specific antigen levels after radical prostatectomy. Int J Radiat Oncol Biol Phys. 2012;82(5):1930–7.

  29. 29.

    Michalski JM, et al. Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2010;76(2):361–8.

  30. 30.

    Andriole GL, et al. The impact of positron emission Tomography with (18)F-Fluciclovine on the management of patients with biochemical recurrence of prostate cancer: results from the LOCATE Trial. J Urol. 2018.

  31. 31.

    U.S. Food and Drug Administration website:

  32. 32.

    European Medicines Agency website:

  33. 33.

    Sörensen J, Owenius R, Lax M, Johansson S. Regional distribution and kinetics of [18F]fluciclovine (anti-[18F]FACBC), a tracer of amino acid transport, in subjects with primary prostate cancer. Eur J Nucl Med Mol Imaging. 2013;40(3):394–402.

  34. 34.

    McParland BJ, Wall A, Johansson S, Sørensen J. The clinical safety, biodistribution and internal radiation dosimetry of [18F]fluciclovine in healthy adult volunteers. Eur J Nucl Med Mol Imaging. 2013;40(8):1256–64.

  35. 35.

    Grubmüller B, Baltzer PA, Hartenbach S, D’Andrea D, Helbich TH, Haug A, et al. PSMA ligand PET/MRI for primary prostate cancer: staging performance and clinical impact. Clin Cancer Res. 2018.

  36. 36.

    Hicks RM, Simko JP, Westphalen AC, Nguyen HG, Greene KL, Zhang L, et al. Diagnostic accuracy of (68)Ga-PSMA-11 PET/MRI compared with multiparametric MRI in the detection of prostate cancer. Radiology. 2018;18:180788.

  37. 37.

    Zanoni L, Bossert I, Matti A, Schiavina R, Pultrone C, Fanti S, et al. A review discussing fluciclovine ((18)F) PET/CT imaging in the detection of recurrent prostate cancer. Future Oncol. 2018;14(11):1101–15.

  38. 38.

    Parent EE, Schuster DM. Update on (18)F-Fluciclovine PET for prostate cancer imaging. J Nucl Med. 2018;59(5):733–9.

  39. 39.

    Schuster DM, Nanni C, Fanti S, Oka S, Okudaira H, Inoue Y, 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):1986–92.

  40. 40.

    Schuster DM, Taleghani PA, Nieh PT, et al. Characterization of primary prostate carcinoma by anti-1-amino-2-[18F]-fluorocyclobutane-1-carboxylic acid (anti-3- [18F] FACBC) uptake. Am J Nucl Med Mol Imaging. 2013;3:85–96.

  41. 41.

    Ulaner GA, Schuster DM. Amino acid metabolism as a target for breast cancer imaging. PET Clinics. 2018;13(3):437–44.

  42. 42.

    Parent EE, Benayoun M, Ibeanu I, Olson JJ, Hadjipanayis CG, Brat DJ, et al. [(18)F]Fluciclovine PET discrimination between high- and low-grade gliomas. EJNMMI Res. 2018;8(1):67.

  43. 43.

    Sannananja B, Shah HU, Behnia F. 18F-Fluciclovine uptake by an incidentally detected hepatocellular carcinoma in a case of biochemically recurrent prostate cancer. Clin Nucl Med. 2018;43(9):695–6.

  44. 44.

    Amzat R, Taleghani P, Miller DL, et al. Pilot study of the utility of the syntheticPET amino-acid radiotracer anti-1-amino-3-[18F]fluorocyclobutane-1-carboxylic acid for the noninvasive imaging of pulmonary lesions. Mol Imaging Biol. 2013;15:633–43.

  45. 45.

    Schuster DM, Nye JA, Nieh PT, Votaw JR, Halkar RK, Issa MM, 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):434–8.

  46. 46.

    Schuster DM, Votaw JR, Halkar RK, et al. Uptake of the synthetic PET amino acid radiotracer 1-amino-3-18F-fluorocyclobutane-1-carboxylic acid (18F-FACBC) within primary and metastatic brain cancer compared with 18F-fluorodeoxyglucose (18F-FDG) [abstract]. J Nucl Med. 2003;44(suppl):167P.

  47. 47.

    Nguyen QB, Amato R, Riascos R, Ballester L, Tandon N, Blanco A, et al. Fluciclovine, Anti-1-amino-3-[(18)F]-fluorocyclobutane-1-carboxylic acid: a novel radiotracer for meningioma. World Neurosurg. 2018.

  48. 48.

    Husband JE, Padhani AR. Radiologists RCo. Recommendations for cross-sectional imaging in cancer management. London: Royal College of Radiologists; 2006.

  49. 49.

    Nye JA, Schuster DM, Yu W, Camp VM, Goodman MM, Votaw JR. Biodistribution and radiation dosimetry of the synthetic nonmetabolized amino acid analogue anti-18F-FACBC in humans. J Nucl Med. 2007;48(6):1017–20.

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“The guidelines were brought to the attention of SNMMI, the relevant EANM Committees and the National Societies of Nuclear Medicine. The comments and suggestions from SNMMI, the EANM Oncology, Bone and Joint, Radiopharmacy, Neurology, Inflammation and Infection and Dosimetry Committees and the German and Spanish National Societies are highly appreciated and have been considered for this Guideline.”

Author information

Correspondence to Cristina Nanni.

Ethics declarations

Conflict of interest

Cristina Nanni provided consultancy for Blue Earth Diagnostics Ltd. 2018–1019. She was Principal Investigator of the project entitled ANTI-3-18F-FACBC (anti1-amino-3-18F-fluorocyclobutane-1-carboxylic acid) in comparison to 11c-choline PET/CT in the evaluation of patients with prostate cancer radically treated and with rising PSA, "Programma di ricerca Regione- Università 2013-Area 1 "Ricerca Innovativa", Bando "Alessandro Liberati"-Giovani Ricercatori".

Lucia Zanoni had a scientific-only relationship with the company “Blue Earth Diagnostics Ltd.” as Medical Staff of the Sponsored Study BED001 (118/2014/O/Oss), (no financial relationship, no compensation received). Lucia Zanoni was Principal Investigator of the project entitled “18F-FACBC PET/CT for staging high risk prostate cancer” funded by “Programma di ricerca Regione- Università 2013-Area 1 “Ricerca Innovativa”, Bando “Alessandro Liberati-Giovani Ricercatori”. In the context of this project, Lucia Zanoni received a granted 1-year SSN contract as nuclear medicine project manager (both scientific and financial relationship)

Tore Bach-Gansmo is a consultant for BED, and the hospital has received research funding from BED.

Heikki Minn institution (Turku University Hospital) has a research contract with Blue Earth Diagnostics (not related to fluciclovine).

Frode Willoch has provided consultancy for Blue Earth Diagnostics Ltd. 2016–2017.

Trond Velde Bogsrud received research funding from Blue Earth Diagnostics Ltd, marketer of 18F-fluciclovine (Axumin), to Oslo University Hospital, Oslo, Norway, for clinical studies using 18F-fluciclovine PET/CT in prostate cancer performed together with Bach-Gansmo T.

Ephraim Parent participates in research funded in part by Blue Earth Diagnostics.

Bital Savir-Baruch had grant support by Blue Earth Diagnostics.

Dr. Eugene Teoh was a consultant to Blue Earth Diagnostics and affiliated to Oxford University, at time of contribution to the published work. At time of subsequent publication, Dr. Eugene Teoh is an employee of Blue Earth Diagnostics.

Fenton Ingram RT(R), CNMT, PET has no financial or non-financial conflict of interest to declare.

Stefano Fanti, with respect to the mentioned paper, declares that he attended an advisory board of Blue Earth Diagnostics in 2014 and in 2015.

David Schuster is a Consultant in Syncona, AIM Specialty Health, and participated through the Emory Office of Sponsored Projects in sponsored grants including those funded or partially funded by Blue Earth Diagnostics, Ltd.; Nihon MediPhysics Co, Ltd.; Telix Pharmaceuticals (USA) Inc.; Advanced Accelerator Applications; and FUJIFILM Pharmaceuticals USA, Inc.

Human and animal rights and informed consent

There are no human or animal participants in the study.

Informed consent

This is a procedural guideline so no informed consent was necessary.

Additional information

Liability statement

“This guideline summarizes the views of the EANM Oncology, Bone and Joint Committee, Radiopharmacy, Neurology, Inflammation and Infection and Dosimetry Committees and SNMMI. It reflects recommendations for which the EANM cannot be held responsible. The recommendations should be taken into context of good practice of nuclear medicine and do not substitute for national and international legal or regulatory provisions”

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This article is part of the Tropical Collection on Oncology – Genitourinary


The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international non-profit scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional nonprofit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. SNMMI and EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine.

The SNMMI and EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated.

Each practice guideline, representing a policy statement by the SNMMI/EANM, has undergone a thorough consensus process in which it has been subjected to extensive review.

The SNMMI and EANM recognize that the safe and effective use of diagnostic nuclear medicine imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by those entities not providing these services is not authorized.

These guidelines are an educational tool designed to assist practitioners in providing appropriate care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, both the SNMMI and the EANM caution against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in light of all the circumstances presented. Thus, there is no implication that an approach differing from the guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the guidelines.

The practice of medicine includes both the art and the science of the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognized that adherence to these guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.

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Nanni, C., Zanoni, L., Bach-Gansmo, T. et al. [18F]Fluciclovine PET/CT: joint EANM and SNMMI procedure guideline for prostate cancer imaging—version 1.0. Eur J Nucl Med Mol Imaging 47, 579–591 (2020).

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  • [18F]Fluciclovine
  • PET
  • Prostate cancer
  • Staging
  • Restaging
  • Guideline