Impact of 18F-fluciclovine PET/CT on salvage radiotherapy plans for men with recurrence of prostate cancer postradical prostatectomy

FALCON; Heather Payne; Jamshed Bomanji; David Bottomley; Andrew F. Scarsbrook; Eugene J. Teoh; Fergus V. Gleeson; Kevin M. Bradley; Gerard Andrade; Philip Camilieri; Katherine Hyde; Ruth Macpherson; Neel Patel; Ami Sabharwal; Manil Subesinghe; Albert Chau; Matthew P. Miller; Asim Afaq; Nicholas van As; Sue Chua; Peter Hoskin; Anthony Chambers; Gary J. Cook; Victoria S. Warbey; Sai Han; Hing Y. Leung

doi:10.1097/MNM.0000000000001501

Impact of ¹⁸F-fluciclovine PET/CT on salvage radiotherapy plans for men with recurrence of prostate cancer postradical prostatectomy

FALCON, Heather Payne^*, Jamshed Bomanji, David Bottomley, Andrew F. Scarsbrook, Eugene J. Teoh, Fergus V. Gleeson, Kevin M. Bradley, Gerard Andrade, Philip Camilieri, Katherine Hyde, Ruth Macpherson, Neel Patel, Ami Sabharwal, Manil Subesinghe, Albert Chau, Matthew P. Miller, Asim Afaq, Nicholas van As, Sue ChuaPeter Hoskin, Anthony Chambers, Gary J. Cook, Victoria S. Warbey, Sai Han, Hing Y. Leung

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Objectives Imaging options to localize biochemical recurrence (BCR) of prostate cancer after radical prostatectomy (RP) are limited, especially at low prostate-specific antigen (PSA) levels. The FALCON study evaluated the impact of ¹⁸F-fluciclovine PET/CT on management plans for patients with BCR. Here, we evaluate salvage radiotherapy decisions in patients post-RP. Methods We conducted a subgroup analysis of post-RP patients enrolled in FALCON who had a prescan plan for salvage radiotherapy (± androgen-deprivation therapy). Patients’ treatment plans post-¹⁸F-fluciclovine PET/CT were compared with their prescan plans. Fisher exact test was used to determine the impact of PSA and Gleason sum on positivity and anatomical patterns of uptake. Results Sixty-five (63%) FALCON patients had undergone RP. Of these, 62 (median PSA, 0.32 ng/mL) had a prescan plan for salvage radiotherapy. Twenty-one (34%) had ¹⁸F-fluciclovine-avid lesions. Disease was confined to the prostate bed in 11 patients (52%) and to the pelvis in a further 5 (24%), while 5 (24%) had extrapelvic findings. Trends towards more disseminated disease with increasing PSA or Gleason sum were observed but did not reach statistical significance. Postscan, 25 (40%) patients had a management change; 17 (68%) were changed to the treatment modality (8 to systemic therapy, 8 to active surveillance, 1 other) and 8 (32%) were radiotherapy field modifications. Conclusions Incorporating ¹⁸F-fluciclovine PET/CT into treatment planning may help identify patients suitable for salvage radiotherapy, help augment planned radiotherapy to better target lesions and support the clinician to optimise patient management.

Original language	English
Pages (from-to)	201-211
Number of pages	11
Journal	Nuclear Medicine Communications
Volume	43
Issue number	2
DOIs	https://doi.org/10.1097/MNM.0000000000001501
Publication status	Published - 1 Feb 2022

Keywords

F-Fluciclovine
Biochemical recurrence
PET
Prostate cancer
Salvage radiotherapy

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Cite this

FALCON, Payne, H., Bomanji, J., Bottomley, D., Scarsbrook, A. F., Teoh, E. J., Gleeson, F. V., Bradley, K. M., Andrade, G., Camilieri, P., Hyde, K., Macpherson, R., Patel, N., Sabharwal, A., Subesinghe, M., Chau, A., Miller, M. P., Afaq, A., van As, N., ... Leung, H. Y. (2022). Impact of ¹⁸F-fluciclovine PET/CT on salvage radiotherapy plans for men with recurrence of prostate cancer postradical prostatectomy. Nuclear Medicine Communications, 43(2), 201-211. https://doi.org/10.1097/MNM.0000000000001501

@article{2c53a0266d024a09b47bf26af3a9d590,

title = "Impact of 18F-fluciclovine PET/CT on salvage radiotherapy plans for men with recurrence of prostate cancer postradical prostatectomy",

abstract = "Objectives Imaging options to localize biochemical recurrence (BCR) of prostate cancer after radical prostatectomy (RP) are limited, especially at low prostate-specific antigen (PSA) levels. The FALCON study evaluated the impact of 18F-fluciclovine PET/CT on management plans for patients with BCR. Here, we evaluate salvage radiotherapy decisions in patients post-RP. Methods We conducted a subgroup analysis of post-RP patients enrolled in FALCON who had a prescan plan for salvage radiotherapy (± androgen-deprivation therapy). Patients{\textquoteright} treatment plans post-18F-fluciclovine PET/CT were compared with their prescan plans. Fisher exact test was used to determine the impact of PSA and Gleason sum on positivity and anatomical patterns of uptake. Results Sixty-five (63%) FALCON patients had undergone RP. Of these, 62 (median PSA, 0.32 ng/mL) had a prescan plan for salvage radiotherapy. Twenty-one (34%) had 18F-fluciclovine-avid lesions. Disease was confined to the prostate bed in 11 patients (52%) and to the pelvis in a further 5 (24%), while 5 (24%) had extrapelvic findings. Trends towards more disseminated disease with increasing PSA or Gleason sum were observed but did not reach statistical significance. Postscan, 25 (40%) patients had a management change; 17 (68%) were changed to the treatment modality (8 to systemic therapy, 8 to active surveillance, 1 other) and 8 (32%) were radiotherapy field modifications. Conclusions Incorporating 18F-fluciclovine PET/CT into treatment planning may help identify patients suitable for salvage radiotherapy, help augment planned radiotherapy to better target lesions and support the clinician to optimise patient management.",

keywords = "F-Fluciclovine, Biochemical recurrence, PET, Prostate cancer, Salvage radiotherapy",

author = "FALCON and Heather Payne and Jamshed Bomanji and David Bottomley and Scarsbrook, {Andrew F.} and Teoh, {Eugene J.} and Gleeson, {Fergus V.} and Bradley, {Kevin M.} and Gerard Andrade and Philip Camilieri and Katherine Hyde and Ruth Macpherson and Neel Patel and Ami Sabharwal and Manil Subesinghe and Albert Chau and Miller, {Matthew P.} and Asim Afaq and {van As}, Nicholas and Sue Chua and Peter Hoskin and Anthony Chambers and Cook, {Gary J.} and Warbey, {Victoria S.} and Sai Han and Leung, {Hing Y.}",

note = "Funding Information: H.P. has attended and received honoraria for advisory boards, travel expenses to medical meetings and served as a consultant for Blue Earth Diagnostics Ltd, AstraZeneca, Astellas, Janssen, Sanofi Aventis, Ferring, Bayer and Novartis. D.B. has acted as a speaker for and received travel support from Blue Earth Diagnostics Ltd. E.J.T. is currently an employee of Blue Earth Diagnostics Ltd. J.B. and A.F.S. have no relevant conflicts to disclose. The FALCON Study was sponsored by Blue Earth Diagnostics Ltd with a grant from Innovate UK. Publisher Copyright: Copyright {\textcopyright} 2021 The Author(s). Published by Wolters Kluwer Health, Inc.",

year = "2022",

month = feb,

day = "1",

doi = "10.1097/MNM.0000000000001501",

language = "English",

volume = "43",

pages = "201--211",

journal = "Nuclear Medicine Communications",

issn = "0143-3636",

publisher = "Lippincott Williams and Wilkins",

number = "2",

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FALCON, Payne, H, Bomanji, J, Bottomley, D, Scarsbrook, AF, Teoh, EJ, Gleeson, FV, Bradley, KM, Andrade, G, Camilieri, P, Hyde, K, Macpherson, R, Patel, N, Sabharwal, A, Subesinghe, M, Chau, A, Miller, MP, Afaq, A, van As, N, Chua, S, Hoskin, P, Chambers, A, Cook, GJ , Warbey, VS, Han, S & Leung, HY 2022, 'Impact of ¹⁸F-fluciclovine PET/CT on salvage radiotherapy plans for men with recurrence of prostate cancer postradical prostatectomy', Nuclear Medicine Communications, vol. 43, no. 2, pp. 201-211. https://doi.org/10.1097/MNM.0000000000001501

TY - JOUR

T1 - Impact of 18F-fluciclovine PET/CT on salvage radiotherapy plans for men with recurrence of prostate cancer postradical prostatectomy

AU - FALCON

AU - Payne, Heather

AU - Bomanji, Jamshed

AU - Bottomley, David

AU - Scarsbrook, Andrew F.

AU - Teoh, Eugene J.

AU - Gleeson, Fergus V.

AU - Bradley, Kevin M.

AU - Andrade, Gerard

AU - Camilieri, Philip

AU - Hyde, Katherine

AU - Macpherson, Ruth

AU - Patel, Neel

AU - Sabharwal, Ami

AU - Subesinghe, Manil

AU - Chau, Albert

AU - Miller, Matthew P.

AU - Afaq, Asim

AU - van As, Nicholas

AU - Chua, Sue

AU - Hoskin, Peter

AU - Chambers, Anthony

AU - Cook, Gary J.

AU - Warbey, Victoria S.

AU - Han, Sai

AU - Leung, Hing Y.

N1 - Funding Information: H.P. has attended and received honoraria for advisory boards, travel expenses to medical meetings and served as a consultant for Blue Earth Diagnostics Ltd, AstraZeneca, Astellas, Janssen, Sanofi Aventis, Ferring, Bayer and Novartis. D.B. has acted as a speaker for and received travel support from Blue Earth Diagnostics Ltd. E.J.T. is currently an employee of Blue Earth Diagnostics Ltd. J.B. and A.F.S. have no relevant conflicts to disclose. The FALCON Study was sponsored by Blue Earth Diagnostics Ltd with a grant from Innovate UK. Publisher Copyright: Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.

PY - 2022/2/1

Y1 - 2022/2/1

N2 - Objectives Imaging options to localize biochemical recurrence (BCR) of prostate cancer after radical prostatectomy (RP) are limited, especially at low prostate-specific antigen (PSA) levels. The FALCON study evaluated the impact of 18F-fluciclovine PET/CT on management plans for patients with BCR. Here, we evaluate salvage radiotherapy decisions in patients post-RP. Methods We conducted a subgroup analysis of post-RP patients enrolled in FALCON who had a prescan plan for salvage radiotherapy (± androgen-deprivation therapy). Patients’ treatment plans post-18F-fluciclovine PET/CT were compared with their prescan plans. Fisher exact test was used to determine the impact of PSA and Gleason sum on positivity and anatomical patterns of uptake. Results Sixty-five (63%) FALCON patients had undergone RP. Of these, 62 (median PSA, 0.32 ng/mL) had a prescan plan for salvage radiotherapy. Twenty-one (34%) had 18F-fluciclovine-avid lesions. Disease was confined to the prostate bed in 11 patients (52%) and to the pelvis in a further 5 (24%), while 5 (24%) had extrapelvic findings. Trends towards more disseminated disease with increasing PSA or Gleason sum were observed but did not reach statistical significance. Postscan, 25 (40%) patients had a management change; 17 (68%) were changed to the treatment modality (8 to systemic therapy, 8 to active surveillance, 1 other) and 8 (32%) were radiotherapy field modifications. Conclusions Incorporating 18F-fluciclovine PET/CT into treatment planning may help identify patients suitable for salvage radiotherapy, help augment planned radiotherapy to better target lesions and support the clinician to optimise patient management.

AB - Objectives Imaging options to localize biochemical recurrence (BCR) of prostate cancer after radical prostatectomy (RP) are limited, especially at low prostate-specific antigen (PSA) levels. The FALCON study evaluated the impact of 18F-fluciclovine PET/CT on management plans for patients with BCR. Here, we evaluate salvage radiotherapy decisions in patients post-RP. Methods We conducted a subgroup analysis of post-RP patients enrolled in FALCON who had a prescan plan for salvage radiotherapy (± androgen-deprivation therapy). Patients’ treatment plans post-18F-fluciclovine PET/CT were compared with their prescan plans. Fisher exact test was used to determine the impact of PSA and Gleason sum on positivity and anatomical patterns of uptake. Results Sixty-five (63%) FALCON patients had undergone RP. Of these, 62 (median PSA, 0.32 ng/mL) had a prescan plan for salvage radiotherapy. Twenty-one (34%) had 18F-fluciclovine-avid lesions. Disease was confined to the prostate bed in 11 patients (52%) and to the pelvis in a further 5 (24%), while 5 (24%) had extrapelvic findings. Trends towards more disseminated disease with increasing PSA or Gleason sum were observed but did not reach statistical significance. Postscan, 25 (40%) patients had a management change; 17 (68%) were changed to the treatment modality (8 to systemic therapy, 8 to active surveillance, 1 other) and 8 (32%) were radiotherapy field modifications. Conclusions Incorporating 18F-fluciclovine PET/CT into treatment planning may help identify patients suitable for salvage radiotherapy, help augment planned radiotherapy to better target lesions and support the clinician to optimise patient management.

KW - F-Fluciclovine

KW - Biochemical recurrence

KW - PET

KW - Prostate cancer

KW - Salvage radiotherapy

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U2 - 10.1097/MNM.0000000000001501

DO - 10.1097/MNM.0000000000001501

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