Prospective evaluation of 18F-FACBC PET/CT and PET/MRI versus multiparametric MRI in intermediate- to high-risk prostate cancer patients (FLUCIPRO trial)
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The purpose of this study was to evaluate 18F-FACBC PET/CT, PET/MRI, and multiparametric MRI (mpMRI) in detection of primary prostate cancer (PCa).
Twenty-six men with histologically confirmed PCa underwent PET/CT immediately after injection of 369 ± 10 MBq 18F-FACBC (fluciclovine) followed by PET/MRI started 55 ± 7 min from injection. Maximum standardized uptake values (SUVmax) were measured for both hybrid PET acquisitions. A separate mpMRI was acquired within a week of the PET scans. Logan plots were used to calculate volume of distribution (VT). The presence of PCa was estimated in 12 regions with radical prostatectomy findings as ground truth. For each imaging modality, area under the curve (AUC) for detection of PCa was determined to predict diagnostic performance. The clinical trial registration number is NCT02002455.
In the visual analysis, 164/312 (53%) regions contained PCa, and 41 tumor foci were identified. PET/CT demonstrated the highest sensitivity at 87% while its specificity was low at 56%. The AUC of both PET/MRI and mpMRI significantly (p < 0.01) outperformed that of PET/CT while no differences were detected between PET/MRI and mpMRI. SUVmax and VT of Gleason score (GS) >3 + 4 tumors were significantly (p < 0.05) higher than those for GS 3 + 3 and benign hyperplasia. A total of 442 lymph nodes were evaluable for staging, and PET/CT and PET/MRI demonstrated true-positive findings in only 1/7 patients with metastatic lymph nodes.
Quantitative 18F-FACBC imaging significantly correlated with GS but failed to outperform MRI in lesion detection. 18F-FACBC may assist in targeted biopsies in the setting of hybrid imaging with MRI.
Keywords18F-FACBC Prostate cancer Diffusion-weighted imaging PET/CT PET/MRI
This work was funded in part by the Finnish Cancer Foundation, Turku University Hospital Research Funds (EVO), TYKS-SAPA research fund, Instrumentarium Research Foundation, Sigrid Jusélius Foundation, Finnish Cancer Society, and the Finnish Cultural Foundation Southwest Finland Regional Fund. We thank the staff of Turku PET Centre and Department of Urology, Turku University Hospital, for practical assistance. We thank Jaakko Liippo (Turku University Hospital, Turku, Finland) for his help in scanning the histological slides and David Gauden (Blue Earth Diagnostics, Oxford, UK) for providing the FastLab cassettes used in radiosynthesis.
Compliance with ethical standards
The study was approved by the local ethics committee and each patient gave written informed consent. The study Clinicaltrial.org registration number is NCT02002455.
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