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Effect of F-18-Fluciclovine Positron Emission Tomography on the Management of Patients With Recurrence of Prostate Cancer: Results From the FALCON Trial
Journal article   Open access   Peer reviewed

Effect of F-18-Fluciclovine Positron Emission Tomography on the Management of Patients With Recurrence of Prostate Cancer: Results From the FALCON Trial

Andrew F. Scarsbrook, David Bottomley, Eugene J. Teoh, Kevin M. Bradley, Heather Payne, Asim Afaq, Jamshed Bomanji, Nicholas van As, Sue Chua, Peter Hoskin, …
International journal of radiation oncology, biology, physics, Vol.107(2), pp.316-324
06/01/2020
DOI: 10.1016/j.ijrobp.2020.01.050
PMID: 32068113
url
https://doi.org/10.1016/j.ijrobp.2020.01.050View
Published (Version of record) Open Access

Abstract

Purpose: Early and accurate localization of lesions in patients with biochemical recurrence (BCR) of prostate cancer may guide salvage therapy decisions. The present study, F-18-Fluciclovine PET/CT in biochemicAL reCurrence Of Prostate caNcer (FALCON; NCT02578940), aimed to evaluate the effect of F-18-fluciclovine on management of men with BCR of prostate cancer. Methods and Materials: Men with a first episode of BCR after curative-intent primary therapy were enrolled at 6 UK sites. Patients underwent F-18-fluciclovine positron emission tomography/computed tomography (PET/CT) according to standardized procedures. Clinicians documented management plans before and after scanning, recording changes to treatment modality as major and changes within a modality as other. The primary outcome measure was record of a revised management plan postscan. Secondary endpoints were evaluation of optimal prostate specific antigen (PSA) threshold for detection, salvage treatment outcome assessment based on F-18-fluciclovine-involvement, and safety. Results: F-18-Fluciclovine was well tolerated in the 104 scanned patients (median PSA = 0.79 ng/mL). Lesions were detected in 58 out of 104 (56%) patients. Detection was broadly proportional to PSA level; <= 1 ng/mL, 1 out of 3 of scans were positive, and 93% scans were positive at PSA >2.0 ng/mL. Sixty-six (64%) patients had a postscan management change (80% after a positive result). Major changes (43 out of 66; 65%) were salvage or systemic therapy to watchful waiting (16 out of 66; 24%); salvage therapy to systemic therapy (16 out of 66; 24%); and alternative changes to treatment modality (11 out of 66, 17%). The remaining 23 out of 66 (35%) management changes were modifications of the prescan plan: most (22 out of 66; 33%) were adjustments to planned brachytherapy/radiation therapy to include a F-18-fluciclovine-guided boost. Where F-18-fluciclovine guided salvage therapy, the PSA response rate was higher than when F-18-fluciclovine was not involved (15 out of 17 [88%] vs 28 out of 39 [72%]). Conclusions: F-18-Fluciclovine PET/CT located recurrence in the majority of men with BCR, frequently resulting in major management plan changes. Incorporating F-18-fluciclovine PET/CT into treatment planning may optimize targeting of recurrence sites and avoid futile salvage therapy. (C) 2020 The Authors. Published by Elsevier Inc.
 Oncology Life Sciences & Biomedicine Radiology, Nuclear Medicine & Medical Imaging Science & Technology

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