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A Prospective Head-to-Head Comparison of 18F-Fluciclovine With 68Ga-PSMA-11 in Biochemical Recurrence of Prostate Cancer in PET/CT

Pernthaler, Birgit MD; Kulnik, Roman MD; Gstettner, Christian MD; Salamon, Spela MD; Aigner, Reingard M. MD; Kvaternik, Herbert PhD

doi: 10.1097/RLU.0000000000002703
Original Articles
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Purpose One of the major challenges for all imaging modalities is accurate detection of prostate cancer (PCa) recurrence. Beyond the established 68Ga-PSMA, a novel promising PET tracer in PCa imaging is 18F-fluciclovine. For evaluating the advantages and disadvantages and the comparability, we conducted a prospective head-to-head comparison on 18F-fluciclovine and 68Ga-PSMA-11 in patients with biochemical recurrence of PCa.

Methods 58 patients with biochemical recurrence of PCa after definitive primary therapy were included. Both scans were performed within a time window of mean 9.4 days. All scans were visually analyzed independently on a patient-, region- and lesion-based analysis. All the examinations were performed in the same medical department using identical scanners at any time.

Results The overall detection rate for PCa recurrence was 79.3% in 18F-fluciclovine and 82.8% in 68Ga-PSMA-11 (P = 0.64). Local recurrence was detected in 37.9% on 18F-fluciclovine and in 27.6% on 68Ga-PSMA-11 (P = 0.03). Local pelvic lymph node recurrence was detected on 18F-fluciclovine versus 68Ga-PSMA-11 in 46.6% versus 50%, in extrapelvic lymph node metastases in 41.4% versus 51.7% and in bone metastases in 25.9% versus 36.2%. Lesion-based analysis showed identical findings in local pelvic lymph nodes in 39.7%, in extrapelvic lymph nodes in 22.4%, and in bone metastases in 13.8%.

Conclusions The advantage of 18F-fluciclovine is detecting curable localized disease in close anatomical relation to the urinary bladder, whereas 68Ga-PSMA-11 fails because of accumulation of activity in the urinary bladder. 18F-fluciclovine is almost equivalent to 68Ga-PSMA-11 in detecting distant metastases of PCa recurrence.

From the Division of Nuclear Medicine, Department of Radiology, Medical University of Graz, Auenbruggerplatz, Graz, Austria.

Received for publication May 22, 2019; revision accepted May 22, 2019.

Conflicts of interest and sources of funding: none declared.

Correspondence to: Birgit Pernthaler, MD, Division of Nuclear Medicine, Department of Radiology, Medical University of Graz Auenbruggerplatz 9A, 8036 Graz, Austria. E-mail: birgit.pernthaler@medunigraz.at.

Online date: July 8, 2019

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