Prospective evaluation of 18F-FACBC PET/CT and PET/MRI versus multiparametric MRI in intermediate- to high-risk prostate cancer patients (FLUCIPRO trial)

  • Ivan Jambor
  • Anna Kuisma
  • Esa Kähkönen
  • Jukka Kemppainen
  • Harri Merisaari
  • Olli Eskola
  • Jarmo Teuho
  • Ileana Montoya Perez
  • Marko Pesola
  • Hannu J. Aronen
  • Peter J. Boström
  • Pekka Taimen
  • Heikki Minn
Original Article

Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusions

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.

Keywords

18F-FACBC Prostate cancer Diffusion-weighted imaging PET/CT PET/MRI 

Notes

Acknowledgements

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.

Supplementary material

259_2017_3875_MOESM1_ESM.pdf (1.1 mb)
ESM 1 (PDF 1.13 mb).

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Ivan Jambor
    • 1
    • 2
    • 3
  • Anna Kuisma
    • 4
  • Esa Kähkönen
    • 5
  • Jukka Kemppainen
    • 3
    • 6
  • Harri Merisaari
    • 1
    • 3
    • 7
  • Olli Eskola
    • 3
  • Jarmo Teuho
    • 3
  • Ileana Montoya Perez
    • 1
    • 7
    • 8
  • Marko Pesola
    • 1
  • Hannu J. Aronen
    • 1
    • 8
  • Peter J. Boström
    • 5
  • Pekka Taimen
    • 9
  • Heikki Minn
    • 3
    • 4
  1. 1.Department of Diagnostic RadiologyUniversity of TurkuTurkuFinland
  2. 2.Department of RadiologyUniversity of Massachusetts Medical School – BaystateSpringfieldUSA
  3. 3.Turku PET CentreTurkuFinland
  4. 4.Department of Oncology and RadiotherapyTurku University HospitalTurkuFinland
  5. 5.Department of UrologyTurku University HospitalTurkuFinland
  6. 6.Department of Clinical Physiology and Nuclear MedicineTurku University HospitalTurkuFinland
  7. 7.Department of Information TechnologyUniversity of TurkuTurkuFinland
  8. 8.Medical Imaging Centre of Southwest FinlandTurku University HospitalTurkuFinland
  9. 9.Department of PathologyUniversity of Turku and Turku University HospitalTurkuFinland

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