Original Article

OPEN: Initial Institutional Experience with 18F-Fluciclovine PET-CT in Biochemical Recurrence of Prostate Cancer

Authors: Amy B. Farkas, MD, Edward D. Green, MD, Anson L. Thaggard, MD, Vani Vijayakumar, MD, John C. Henegan, MD, Seth T. Lirette, PhD, Mary R. Nittala, DrPH, Srinivasan Vijayakumar, MD


Objectives: 18F-fluciclovine (fluciclovine) is an amino acid analog approved by the Food and Drug Administration for use as a radiotracer in positron emission tomography (PET) in men with biochemical recurrence of suspected prostate cancer. The purpose of this study was to investigate the initial institutional experience with 18F-fluciclovine in the evaluation of prostate cancer with biochemical recurrence.

Methods: This study was a retrospective review of 135 patients who underwent 18F-fluciclovine PET-computed tomography (PET-CT) at a single institution from August 2018 through January 2020. Prognostic information, including prostate-specific level antigen (PSA) at the time of diagnosis, initial risk, initial Gleason score, and initial stage, was reviewed as well as the PSA level at the time of the scan. The images were reviewed by two radiologists with fellowship training in nuclear medicine and additional training to interpret the fluciclovine studies. A minority of studies were reviewed by a third fellowship-trained radiologist under the guidance of the two nuclear medicine–trained radiologists. In cases with abnormal radiopharmaceutical uptake in lymph nodes, the short-axis dimension of the lymph node or largest lymph node with abnormal uptake was noted. If CT or bone scan was performed within 4 months of the 18F-fluciclovine PET-CT, findings on the alternate imaging were compared with the results of the 18F-fluciclovine PET-CT.

Results: Our institutional positivity rate was 75.6%, with 64 (67.4%) patients with metastatic disease and 71 (52.6%) patients with local recurrence detected by fluciclovine. As expected, the rate of positive examinations increased with increasing PSA values measured at the time of imaging (P < 0.001). Of the 54 patients with nodal disease, 35 had nonpathologically enlarged lymph nodes measuring <1 cm in maximum short-axis dimension. In more than half of the patients in this study, with conventional imaging, fluciclovine either discovered otherwise undetectable metastatic disease or suggested the presence of local recurrence.

Conclusions: Our single-institution experience with 18F-fluciclovine PET-CT has the largest number of patients to date in the literature and demonstrates the ability of fluciclovine to help guide clinical management in the detection of early recurrent disease.
Posted in: Nephrology and Urology18 Urologic Cancer1 Prostate Disorders1

Full Article

Having trouble viewing the article content below? Click here to open it directly.


Table 1. Patient demographics

Download Image

Table 2. Fluciclovine PET/CT interpretation

Download Image

Table 3. Prognostic information and local recurrence

Download Image

Table 4. Prognostic information and metastatic disease

Download Image

Table 5. Rate of positivity by PSA at time of scan

Download Image


1. Kattan MW, Wheeler TM, Scardino PT. Postoperative normogram for disease recurreucne after radical prostatectomy for prostate cancer. J Clin Oncol 1999;17:1499–1507.
2. Zumsteg ZS, Spratt DE, Romesser PB, et al. Anatomical patterns of recurrence following biochemical relapse in the dose escalation era of eternal beam radiotherapy for prostate cancer. Eur Urol 2015;194:1624–1630.
3. Triggiani L, Alongi F, Buglione M, et al. Efficacy of stereotactic body radiotherapy in oligorecurrent and in oligoprogressive prostate cancer: new evidence from a multicentric study. Br J Cancer 2017;116:1520–1525.
4. Slaoui A, Albisinni S, Aoun F, et al. A systematic review of contemporary management of oligometastatic prostate cancer: fighting a challenge or tilting at windmills? World J Urol 2019;37:2343–2353.
5. McCrea EM, Lee DK, Sissung TM, et al. Precision medicine applications in prostate cancer. Ther Adv Med Oncol 2018;10:1758835918776920.
6. Ramirez de Molina A, Rodriguez-Gonzalez A, Gutierrez R, et al. Overexpression of choline kinase is a frequent feature in human tumorderived cell lines and in lung, prostate, and colorectal human cancers. Biochem Biophys Res Commun 2002;296:580–583.
7. FDA approves 11C-choline for PET in prostate cancer. J Nucl Med 2012;53:11N.
8. Nanni C, Schiavina R, Brunocilla E, et al. 18F-fluciclovine PET/CT for the detection of prostate cancer relapse: a comparison to 11C-choline PET/CT. Clin Nucl Med 2015;40:e386–e391.
9. Akin-Akintayo OO, Jani AB, Odewole O, et al. Change in salvage radiotherapy management based on guidance with FACBC (fluciclovine) PET/CT in postprostatectomy recurrent prostate cancer. Clin Nucl Med 2017;42:22–28.
10. Andriole GL, Kostakoglu L, Chau A, et al. The impact of positron emission tomography with 18F-fluciclovine on the treatment of biochemical recurrence of prostate cancer: results from the LOCATE trial. J Urol 2019;201:322–331.
11. Odewole OA, Tade FI, Nieh PT, et al. Recurrent prostate cancer detection with anti-3- [18F]FACBC PET-CT: comparison with CT. Eur J Nucl Med Mol Imaging 2016;43:1773–1783.
12. Miller MP, Kostakoglu L, Pryma D, et al. Reader training for the restaging of biochemically recurrent prostate cancer using 18F-fluciclovine PET/CT. J Nucl Med 2017;58:1596–1602.
13. Savir-Baruch B, Banks KP, McConathy JE, et al. ACR-ACNM practice parameter for the performance of fluorine-18 fluciclovine-PET/CT for recurrent prostate cancer. Clin Nucl Med 2018;43:909–917.
14. Sternberg CN, Beltran H. Prostate cancer in 2016: improved outcomes and precision medicine come within reach. Nat Rev Urol 2017;14:71–72.
15. Ku SY, Gleave ME, Beltran H. Towards precision oncology in advanced prostate cancer. Nat Rev Urol 2019;16:645–654.
16. Vijayakumar S, Roberts PR, Packianathan S. Precision medicine in cancer prevention: exploring applications in Mississippi and beyond. J Miss State Med Assoc 2017;58:4–7.
17. Joice GA, Rowe SP, Pienta KJ, et al. Oligometastatic prostate cancer: shaping the definition with molecular imaging and an improved understanding of tumor biology. Curr Opin Urol 2017;27:533–541.
18. Parent EE, Schuster DM. Update on 18F-fluciclovine PET for prostate cancer imaging. J Nucl Med 2018;59:733–739.