We have all been ever increasingly aware of the weakness of our scanning technologies when it comes to both diagnosing prostate cancer and its recurrence. Given that about 1/3 of all primary treatments for prostate cancer will fail and the cancer will return it is vital that we improve our ability to detect prostate cancer recurrences earlier.
In recent years, there have been a few improved contrasts developed that have increased scanning sensitivity. Two competing contrasts are a new PET compound (anti-3-(18)F-FACBC or (18)F-fluciclovine) and (11)C-choline.
Researchers set out to compare these two contrasts for their sensitivity to detect a prostate cancer relapse in men presenting with a biochemical relapse. They evaluated fifty men who had a radical prostatectomy and who were presenting with rising prostate-specific antigen (PSA) levels. All the men underwent both (11)C-choline PET/CT and (18)F-fluciclovine PET/CT within 1 week.
They then compared the results in terms of detection rate of lesions. Furthermore, a more detailed analysis regarding local, lymph node, and bone relapse was performed.
They found that on a patient-based analysis, (18)F-fluciclovine detection turned out to be significantly superior to (11)C-choline. This result was also true on lesion, lymph node, bone lesion, and local relapse analysis. When the patients were divided into groups with different PSA levels, (18)F-fluciclovine had a superior detection rate for low, intermediate, and high PSA levels.
In summary, they found that (18)F-fluciclovine provided a statistically significant superior performance in terms of lesion detection rate as compared with (11)C-choline.
In May, the FDA approved (18)F-fluciclovine contrast for recurrent prostate cancer, so it should be available soon in the nuclear medicine unit near you.
Clin Nucl Med. 2015 Aug;40(8):e386-91. doi: 10.1097/RLU.0000000000000849: Nanni C1, Schiavina R, Brunocilla E, Boschi S, Borghesi M, Zanoni L, Pettinato C, Martorana G, Fanti S.
Disclosure: I work in NM in a Boston teaching hospital. I am not a clinician.
[June 2016] (18)F-fluciclovine, or Axumin, is being handled by Siemen’s PETNET. They are being, thankfully, very aggressive in the rollout and report that “PETNET will initially have product available for commercial use in two markets, Hackensack and Jacksonville – the sites that were on Blue Earth’s NDA submission to the FDA. We are also in production in Louisville and San Diego and can distribute clinical trial doses from those locations. Following NDA amendment approval and FDA inspections, we anticipate commercial availability from those sites by August. We estimate a September / October time frame for the remainder of the 11 launch sites … Axumin is going to be available in Boston by September 1st. It will be available 1 day a week to start (not sure which) and full CMS coverage most likely not before Jan 1 but Blue Earth is actively working to get this sooner.”
As a patient I view this as a revolutionary development in which localized lesions, especially those outside the bones which cannot be detected with current technology, can be identified and eliminated (e.g. by Cyberknife) before they become advanced.
Larry, Thank you for the information.