title: Recurrent prostate cancer detection with anti-3-[(18)F]FACBC PET/CT: comparison with CT.
abstract: OBJECTIVE
  To compare the diagnostic performance of the synthetic amino acid analogue PET radiotracer anti-3-[(18)F]FACBC (fluciclovine) with that of CT in the detection of recurrent prostate carcinoma.
  
  
  METHODS
  This was a retrospective analysis of 53 bone scan-negative patients with suspected recurrent prostate carcinoma who underwent fluciclovine PET/CT and routine clinical CT within 90 days of each other. The correlation between imaging findings and histology and clinical follow-up was evaluated. Positivity rates and diagnostic performance were calculated for fluciclovine PET/CT and CT.
  
  
  RESULTS
  Of 53 fluciclovine PET/CT and 53 CT examinations, 41 (77.4 %) and 10 (18.9 %), respectively, had positive findings for recurrent disease. Positivity rates were higher with fluciclovine PET/CT than with CT at all prostate-specific antigen (PSA) levels, PSA doubling times and original Gleason scores. In the prostate/bed, fluciclovine PET/CT was true-positive in 31 and CT was true-positive in 4 of 51 patients who met the reference standard. In extraprostatic regions, fluciclovine PET/CT was true-positive in 12 and CT was true-positive in 3 of 41 patients who met the reference standard. Of the 43 index lesions used to prove positivity, 42 (97.7 %) had histological proof. In 51 patients with sufficient follow-up to calculate diagnostic performance in the prostate/bed, fluciclovine PET/CT demonstrated a sensitivity of 88.6 %, a specificity of 56.3 %, an accuracy of 78.4 %, a positive predictive value (PPV) of 81.6 %, and a negative predictive value (NPV) of 69.2 %; the respective values for CT were 11.4 %, 87.5 %, 35.3 %, 66.7 % and 31.1 %. In 41 patients with sufficient follow-up to calculate diagnostic performance in extraprostatic regions, fluciclovine PET/CT demonstrated a sensitivity of 46.2 %, a specificity of 100 %, an accuracy of 65.9 %, a PPV of 100 %, and an NPV of 51.7 %; the respective values for CT were 11.5 %, 100 %, 43.9 %, 100 % and 39.5 %.
  
  
  CONCLUSIONS
  The diagnostic performance of fluciclovine PET/CT in recurrent prostate cancer is superior to that of CT and fluciclovine PET/CT provides better delineation of prostatic from extraprostatic recurrence.
authors.affiliation: Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.
authors.forename: Oluwaseun A
authors.initials: OA
authors.lastname: Odewole
authors.affiliation: Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.
authors.forename: Funmilayo I
authors.initials: FI
authors.lastname: Tade
authors.affiliation: Urology, Emory University, Atlanta, GA, USA.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Nieh
authors.affiliation: Radiology, Loyola University Medical Centre, Maywood, IL, USA.
authors.forename: Bital
authors.initials: B
authors.lastname: Savir-Baruch
authors.affiliation: Radiation Oncology, Emory University, Atlanta, GA, USA.
authors.forename: Ashesh B
authors.initials: AB
authors.lastname: Jani
authors.affiliation: Urology, Emory University, Atlanta, GA, USA.
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
authors.affiliation: Radiation Oncology, Emory University, Atlanta, GA, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Rossi
authors.affiliation: Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.
authors.forename: Raghuveer K
authors.initials: RK
authors.lastname: Halkar
authors.affiliation: Urology, Emory University, Atlanta, GA, USA.|Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA.
authors.forename: Adeboye O
authors.initials: AO
authors.lastname: Osunkoya
authors.affiliation: Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.
authors.forename: Oladunni
authors.initials: O
authors.lastname: Akin-Akintayo
authors.affiliation: Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Zhengjia
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Goodman
authors.affiliation: Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA. dschust@emory.edu.|Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road, Atlanta, GA, 30322, USA. dschust@emory.edu.
authors.forename: David M
authors.initials: DM
authors.lastname: Schuster
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D002264:Carboxylic Acids; D003503:Cyclobutanes; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000517:prevention & control; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D002264:Carboxylic Acids; D003503:Cyclobutanes; D019275:Radiopharmaceuticals; C117460:fluciclovine F-18
keywords: CT; Diagnostic performance; FACBC; Fluciclovine; PET; Prostate cancer