Prostatectomy

Prostate cancer

Target lesion

Lymph node

Radiology

Lesion

Percutaneous coronary intervention

Lymph

Biochemical recurrence

Myocardial infarction

Internal medicine

Prostate

Prospective cohort study

Oncology

Medicine

Nuclear medicine

Cancer

Pathology

Clinical Nuclear Medicine

Purpose One of the major challenges for all imaging modalities is accurate detection of prostate cancer (PCa) recurrence. Beyond the established 68 Ga-PSMA, a novel promising PET tracer in PCa imaging is 18 F-fluciclovine. For evaluating the advantages and disadvantages and the comparability, we conducted a prospective head-to-head comparison on 18 F-fluciclovine and 68 Ga-PSMA-11 in patients with biochemical recurrence of PCa. Methods 58 patients with biochemical recurrence of PCa after definitive primary therapy were included. Both scans were performed within a time window of mean 9.4 days. All scans were visually analyzed independently on a patient-, region- and lesion-based analysis. All the examinations were performed in the same medical department using identical scanners at any time. Results The overall detection rate for PCa recurrence was 79.3% in 18 F-fluciclovine and 82.8% in 68 Ga-PSMA-11 ( P = 0.64). Local recurrence was detected in 37.9% on 18 F-fluciclovine and in 27.6% on 68 Ga-PSMA-11 ( P = 0.03). Local pelvic lymph node recurrence was detected on 18 F-fluciclovine versus 68 Ga-PSMA-11 in 46.6% versus 50%, in extrapelvic lymph node metastases in 41.4% versus 51.7% and in bone metastases in 25.9% versus 36.2%. Lesion-based analysis showed identical findings in local pelvic lymph nodes in 39.7%, in extrapelvic lymph nodes in 22.4%, and in bone metastases in 13.8%. Conclusions The advantage of 18 F-fluciclovine is detecting curable localized disease in close anatomical relation to the urinary bladder, whereas 68 Ga-PSMA-11 fails because of accumulation of activity in the urinary bladder. 18 F-fluciclovine is almost equivalent to 68 Ga-PSMA-11 in detecting distant metastases of PCa recurrence.

A Prospective Head-to-Head Comparison of 18F-Fluciclovine With 68Ga-PSMA-11 in Biochemical Recurrence of Prostate Cancer in PET/CT