In comparison to CT, the fluciclovine PET positivity rate for recurrent disease was 77.4% versus 18.9%, although sensitivity varies with PSA level, PSADT, and original Gleason Score [59]. One- hundred patients with biochemical failure after RP underwent choline PET and fluciclovine PET in a single-center trial [60-62]. The investigators reported choline and fluciclovine had overall sensitivities of 32% and 37%, specificities of 40% and 67%, and positive predictive values of 90% and 97%, respectively, with fluciclovine having a lower physiologic background, resulting in better lesion contrast, and the practical advantage of a longer half-life enabling more widespread distribution compared with a short half-life C-11 radiotracer. Notably, in this single-center comparison from Italy, the C-11 choline dose used was only about one-third of that used for most patients imaged clinically with choline in the United States, and the performance of both agents reported was much lower than that of many other studies, with the meta-analysis of choline showing a sensitivity of 85.6% and a specificity of 92.6% for all sites of recurrence, and a meta-analysis of fluciclovine that reported an 87% pooled Fluciclovine PET/MRI Skull Base to Mid-Thigh There is limited evidence to support the use of fluciclovine PET/MRI for the follow-up of a patient with a clinical concern for residual or recurrent disease, status post-RP. PET Using Other Agents: There are many additional prostate-specific tracers that are not FDA approved, including 11C-acetate [70,71], 18F-choline [72-75], Bombesin, and 18F-fluorodihydrotestosterone [76-78], that are in various stages of investigation and have been reported to detect local and metastatic recurrent disease in patients with biochemical failure after local treatment. These agents remain investigational, but some have shown excellent results and hold great potential.
Post Treatment Follow up of Prostate Cancer. In comparison to CT, the fluciclovine PET positivity rate for recurrent disease was 77.4% versus 18.9%, although sensitivity varies with PSA level, PSADT, and original Gleason Score [59]. One- hundred patients with biochemical failure after RP underwent choline PET and fluciclovine PET in a single-center trial [60-62]. The investigators reported choline and fluciclovine had overall sensitivities of 32% and 37%, specificities of 40% and 67%, and positive predictive values of 90% and 97%, respectively, with fluciclovine having a lower physiologic background, resulting in better lesion contrast, and the practical advantage of a longer half-life enabling more widespread distribution compared with a short half-life C-11 radiotracer. Notably, in this single-center comparison from Italy, the C-11 choline dose used was only about one-third of that used for most patients imaged clinically with choline in the United States, and the performance of both agents reported was much lower than that of many other studies, with the meta-analysis of choline showing a sensitivity of 85.6% and a specificity of 92.6% for all sites of recurrence, and a meta-analysis of fluciclovine that reported an 87% pooled Fluciclovine PET/MRI Skull Base to Mid-Thigh There is limited evidence to support the use of fluciclovine PET/MRI for the follow-up of a patient with a clinical concern for residual or recurrent disease, status post-RP. PET Using Other Agents: There are many additional prostate-specific tracers that are not FDA approved, including 11C-acetate [70,71], 18F-choline [72-75], Bombesin, and 18F-fluorodihydrotestosterone [76-78], that are in various stages of investigation and have been reported to detect local and metastatic recurrent disease in patients with biochemical failure after local treatment. These agents remain investigational, but some have shown excellent results and hold great potential.