Effect of 18F-fluciclovine positron emission tomography on the management of patients with recurrence of prostate cancer: results from the FALCON trial

Scarsbrook, Andrew F., Bottomley, David, Teoh, Eugene J., Bradley, Kevin M. ORCID: https://orcid.org/0000-0003-1911-3382, Payne, Heather, Afaq, Asim, Bomanji, Jamshed, van As, Nicholas, Chua, Sue, Hoskin, Peter, Chambers, Anthony, Cook, Gary J., Warbey, Victoria S., Han, Sai, Leung, Hing Y., Chau, Albert, Miller, Matthew P., Gleeson, Fergus V., Andrade, Gerard, Camilieri, Philip, Hyde, Katherine, Macpherson, Ruth, Patel, Neel, Sabharwal, Ami, Subesinghe, Manil and Tsakok, Maria 2020. Effect of 18F-fluciclovine positron emission tomography on the management of patients with recurrence of prostate cancer: results from the FALCON trial. International Journal of Radiation Oncology - Biology - Physics 107 (2) , pp. 316-324. 10.1016/j.ijrobp.2020.01.050

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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, 18F-Fluciclovine PET/CT in biochemicAL reCurrence Of Prostate caNcer (FALCON; NCT02578940), aimed to evaluate the effect of 18F-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 18F-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 18F-fluciclovine-involvement, and safety. Results 18F-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 18F-fluciclovine-guided boost. Where 18F-fluciclovine guided salvage therapy, the PSA response rate was higher than when 18F-fluciclovine was not involved (15 out of 17 [88%] vs 28 out of 39 [72%]). Conclusions 18F-Fluciclovine PET/CT located recurrence in the majority of men with BCR, frequently resulting in major management plan changes. Incorporating 18F-fluciclovine PET/CT into treatment planning may optimize targeting of recurrence sites and avoid futile salvage therapy.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Elsevier
ISSN:	0360-3016
Date of First Compliant Deposit:	1 June 2020
Date of Acceptance:	31 January 2020
Last Modified:	06 May 2023 10:24
URI:	https://orca.cardiff.ac.uk/id/eprint/131976

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