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We evaluated F-fluciclovine uptake parameters that correlate with true positivity for local recurrence in non-prostatectomy treated patients. Twenty-one patients (prostate-specific antigen 7.4±6.8 ng/ml) with biochemical recurrence after non-prostatectomy local therapy (radiotherapy and cryotherapy) had dual time-point F-fluciclovine (364.1±37.7 MBq) positron emission tomography (PET)/computed tomography from pelvis to diaphragm. Prostatic uptake over background was delineated and co-registered to a prostate biopsy planning ultrasound. Trans-rectal biopsies of F-fluciclovine defined targets were completed using a 3-D visualization and navigation platform. Histologic analyses of lesions were completed. Lesion characteristics including maximum standardized uptake value (SUV), target-to-background ratio (TBR), uptake pattern, and subjective reader's suspicion level were compared between true positive (malignant) and false positive (benign) lesions. Univariate analysis was used to determine the association between PET and histologic findings. Receiver Operating Characteristic (ROC) curves were plotted to determine discriminatory cut-off points of TBR. Statistical significance was set at p<0.05. Fifty lesions were identified in 21 patients on PET. 17/50 (34.0%) targeted lesions in 10/21 patients were positive for malignancy. True positive lesions had significantly higher SUV (6.62±1.70 vs 4.92±1.27), TBR (marrow) (2.57±0.81 vs 1.69±0.51), and TBR (blood pool) (4.10±1.17 vs 2.99±1.01) than false positive lesions at the early time-point (p<0.01), and remained significant at the delayed time-point except TBR (blood pool). Focal uptake (Odds Ratio (OR): 12.07 [95% Confidence Interval (CI): 2.98-48.80], p<0.01) and subjective highest suspicion level (
1.19-99.69], = 0.03) correlated with true positivity. Using the ROC, optimal cut-offs for TBR (marrow) were 1.9 (Area under the curve [AUC]=0.82) and 1.8 (AUC=0.85) at early and delayed imaging, respectively. With these cut-offs, 15/17 malignant lesions were identified at both time-points, however, fewer false positive lesions were detected at delayed (5/33) compared to early (11/33) time-point. True positivity of F-fluciclovine targeted prostate biopsy in non-prostatectomy treated patients correlates with focal uptake, TBR (blood pool and marrow), and subjective highest suspicion level. TBR (marrow) of 1.9 at early time-point and 1.8 at delayed time-point had optimal discriminating capabilities. Despite the relatively low intra-prostate positive predictive value (34.0%) with F-fluciclovine, application of these parameters to interpretative criteria may improve true positivity in the treated prostate.
This article was published in the following journal.
Name: Journal of nuclear medicine : official publication, Society of Nuclear Medicine
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Proteins secreted by the prostate gland. The major secretory proteins from the human prostate gland include PROSTATE-SPECIFIC ANTIGEN, prostate-specific acid phosphatase, prostate-specific membrane antigen, and prostate-specific protein-94.
A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer.
Conducting a biopsy procedure with the aid of a MEDICAL IMAGING modality.
Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (IMMUNOTOXINS) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (see RADIOTHERAPY).
Removal of all or part of the PROSTATE, often using a cystoscope and/or resectoscope passed through the URETHRA.
Prostate cancer (cancer de prostata) Prostate cancer (cancer de prostata) is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostat...