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A PET/MRI study towards finding the optimal [18F]Fluciclovine PET protocol for detection and characterisation of primary prostate cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

[18F]Fluciclovine PET imaging shows promise for the assessment of prostate cancer. The purpose of this PET/MRI study is to optimise the PET imaging protocol for detection and characterisation of primary prostate cancer, by quantitative evaluation of the dynamic uptake of [18F]Fluciclovine in cancerous and benign tissue.

Methods

Patients diagnosed with high-risk primary prostate cancer underwent an integrated [18F]Fluciclovine PET/MRI exam before robot-assisted radical prostatectomy with extended pelvic lymph node dissection. Volumes-of-interest (VOIs) of selected organs (prostate, bladder, blood pool) and sub-glandular prostate structures (tumour, benign prostatic hyperplasia (BPH), inflammation, healthy tissue) were delineated on T2-weighted MR images, using whole-mount histology samples as a reference. Three candidate windows for optimal PET imaging were identified based on the dynamic curves of the mean and maximum standardised uptake value (SUVmean and SUVmax, respectively). The statistical significance of differences in SUV between VOIs were analysed using Wilcoxon rank sum tests (p<0.05, adjusted for multiple testing).

Results

Twenty-eight (28) patients [median (range) age: 66 (55-72) years] were included. An early (W1: 5-10 minutes post-injection) and two late candidate windows (W2: 18-23; W3: 33-38 minutes post-injection) were selected. Late compared with early imaging was better able to distinguish between malignant and benign tissue [W3, SUVmean: tumour vs. BPH 2.5 vs. 2.0 (p<0.001), tumour vs. inflammation 2.5 vs. 1.7 (p<0.001), tumour vs. healthy tissue 2.5 vs. 2.0 (p<0.001); W1, SUVmean: tumour vs. BPH 3.1 vs. 3.1 (p=0.771), tumour vs inflammation 3.1 vs. 2.2 (p=0.021), tumour vs. healthy tissue 3.1 vs. 2.5 (p<0.001)] as well as between high-grade and low/intermediate-grade tumours (W3, SUVmean: 2.6 vs. 2.1 (p=0.040); W1, SUVmean: 3.1 vs. 2.8 (p=0.173)). These differences were relevant to the peripheral zone, but not the central gland.

Conclusion

Late-window [18F]Fluciclovine PET imaging shows promise for distinguishing between prostate tumours and benign tissue and for assessment of tumour aggressiveness.

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Acknowledgments

The authors acknowledge Professor Frode Willoch, Institute of Basic Medical Sciences, University of Oslo, for his support with [18F]Fluciclovine PET imaging.

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Authors and Affiliations

  1. Deparment of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Mail MTFS*3.1313, POBox 8905, N-7491, Trondheim, Norway

    Mattijs Elschot, Kirsten M. Selnæs, Elise Sandsmark, Brage Krüger-Stokke, May-Britt Tessem, Siver A. Moestue & Tone F. Bathen

  2. St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    Kirsten M. Selnæs & Tone F. Bathen

  3. Department of Radiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    Brage Krüger-Stokke

  4. Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    Øystein Størkersen

  5. Department of Laboratory Medicine, Children’s and Women’s Health, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway

    Siver A. Moestue

  6. Department of Urology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    Helena Bertilsson

  7. Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway

    Helena Bertilsson

Authors
  1. Mattijs Elschot
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  2. Kirsten M. Selnæs
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  6. May-Britt Tessem
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  9. Tone F. Bathen
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Corresponding author

Correspondence to Mattijs Elschot.

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Funding

This study was funded by The Norwegian Cancer Society (grant number 100792).

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Elschot, M., Selnæs, K.M., Sandsmark, E. et al. A PET/MRI study towards finding the optimal [18F]Fluciclovine PET protocol for detection and characterisation of primary prostate cancer. Eur J Nucl Med Mol Imaging 44, 695–703 (2017). https://doi.org/10.1007/s00259-016-3562-7

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  • DOI: https://doi.org/10.1007/s00259-016-3562-7

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