Source:Practical Radiation Oncology
Author(s): Jaden D. Evans, Krishan R. Jethwa, Piet Ost, Scott Williams, Eugene D. Kwon, Val J. Lowe, Brian J. Davis
Prostate cancer-specific positron emission tomography (pcPET) has been shown to detect sites of disease recurrence at serum prostate specific antigen (PSA) levels that are lower than those levels detected by conventional imaging. Commonly used pcPET radiotracers in the setting of biochemical recurrence are reviewed including C-11/F-18 choline, Ga-68/F-18 PSMA, and F-18 fluciclovine. Review of the literature generally favors PSMA-based agents for the detection of recurrence as a function of low PSA levels. Positive Ga-68/F-18 PSMA PET/CT scans detected potential sites of recurrence in a median 51.5% of patients when PSA level is <1.0ng/mL, 74% of patients when PSA level is 1.0–2.0ng/mL, and 90.5% of patients when PSA level is >2.0ng/mL. Review of C-11/F-18 choline and F-18 fluciclovine data commonly demonstrated lower detection rates for each respective PSA cohort, although with some important caveats, despite having similar operational characteristics to PSMA-based imaging. Sensitive pcPET imaging has provided new insight into the early patterns of disease spread, which has prompted judicious re-consideration of additional local therapy either after prostatectomy, definitive radiotherapy or post-prostatectomy radiotherapy. This review discusses the literature, clinical utility, availability and fundamental understanding of pcPET imaging needed to improve clinical practice.
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