title: (18)F-FACBC (anti1-amino-3-(18)F-fluorocyclobutane-1-carboxylic acid) versus (11)C-choline PET/CT in prostate cancer relapse: results of a prospective trial.
abstract: OBJECTIVE
  To compare the accuracy of (18)F-FACBC and (11)C-choline PET/CT in patients radically treated for prostate cancer presenting with biochemical relapse.
  
  
  METHODS
  This prospective study enrolled 100 consecutive patients radically treated for prostate cancer and presenting with rising PSA. Of these 100 patients, 89 were included in the analysis. All had biochemical relapse after radical prostatectomy (at least 3 months previously), had (11)C-choline and (18)F-FACBC PET/CT performed within 1 week and were off hormonal therapy at the time of the scans. The two tracers were compared directly in terms of overall positivity/negativity on both a per-patient basis and a per-site basis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated for both the tracers; follow-up at 1 year (including correlative imaging, PSA trend and pathology when available) was considered as the standard of reference.
  
  
  RESULTS
  In 51 patients the results were negative and in 25 patients positive with both the tracers, in eight patients the results were positive with (18)F-FACBC but negative with (11)C-choline, and in five patients the results were positive with (11)C-choline but negative with (18)F-FACBC. Overall in 49 patients the results were false-negative (FN), in two true-negative, in 24 true-positive (TP) and in none false-positive (FP) with both tracers. In terms of discordances between the tracers: (1) in one patient, the result was FN with (11)C-choline but FP with (18)F-FACBC (lymph node), (2) in seven, FN with (11)C-choline but TP with (18)F-FACBC (lymph node in five, bone in one, local relapse in one), (3) in one, FP with (11)C-choline (lymph node) but TP with (18)F-FACBC (local relapse), (4) in two, FP with (11)C-choline (lymph nodes in one, local relapse in one) but FN with (18)F-FACBC, and (5) in three, TP with (11)C-choline (lymph nodes in two, bone in one) but FN with (18)F-FACBC. With (11)C-choline and (18)F-FACBC, sensitivities were 32 % and 37 %, specificities 40 % and 67 %, accuracies 32 % and 38 %, PPVs 90 % and 97 %, and NPVs 3 % and 4 %, respectively. Categorizing patients by PSA level (<1 ng/ml 28 patients, 1 - <2 ng/ml 28 patients, 2 - <3 ng/ml 11 patients, ≥3 ng/ml 22 patients), the number (percent) of patients with TP findings were generally higher with (18)F-FACBC than with (11)C-choline: six patients (21 %) and four patients (14 %), eight patients (29 %) and eight patients (29 %), five patients (45 %) and four patients (36 %), and 13 patients (59 %) and 11 patients (50 %), respectively.
  
  
  CONCLUSIONS
  (18)F-FACBC can be considered an alternative tracer superior to (11)C-choline in the setting of patients with biochemical relapse after radical prostatectomy.
authors.affiliation: Nuclear Medicine, AOU Policlinico S.Orsola-Malpighi, Via Massarenti, 9 40138, Bologna, Italy. cnanni@aosp.bo.it.
authors.forename: Cristina
authors.initials: C
authors.lastname: Nanni
authors.affiliation: Nuclear Medicine, AOU Policlinico S.Orsola-Malpighi, Via Massarenti, 9 40138, Bologna, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Zanoni
authors.affiliation: Urology, AOU Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Pultrone
authors.affiliation: Urology, AOU Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.affiliation: Urology, AOU Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Brunocilla
authors.affiliation: Nuclear Medicine, AOU Policlinico S.Orsola-Malpighi, Via Massarenti, 9 40138, Bologna, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Lodi
authors.affiliation: Nuclear Medicine, AOU Policlinico S.Orsola-Malpighi, Via Massarenti, 9 40138, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Malizia
authors.affiliation: Urology, Centro Avanzato di Urotecnologie, Istituto Auxologico Italiano , Presidio Ospedaliero Capitanio, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ferrari
authors.affiliation: Urology, Centro Avanzato di Urotecnologie, Istituto Auxologico Italiano , Presidio Ospedaliero Capitanio, Milan, Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.affiliation: Nuclear Medicine, AOU Policlinico S.Orsola-Malpighi, Via Massarenti, 9 40138, Bologna, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Fonti
authors.affiliation: Urology, AOU Policlinico S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
authors.affiliation: Nuclear Medicine, AOU Policlinico S.Orsola-Malpighi, Via Massarenti, 9 40138, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000556:secondary; D002250:Carbon Radioisotopes; D002264:Carboxylic Acids; D002794:Choline; D003503:Cyclobutanes; D005188:False Negative Reactions; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D012008:Recurrence
chemical_list: D002250:Carbon Radioisotopes; D002264:Carboxylic Acids; D003503:Cyclobutanes; C117460:fluciclovine F-18; D017430:Prostate-Specific Antigen; D002794:Choline
keywords: 11C-Choline; Anti-3-18F-FACBC; Fluciclovine; PET/CT; PSA; Prostate cancer