¹⁸F-fluciclovine PET/CT detection of biochemical recurrent prostate cancer in patients with PSA levels <2.00 ng/mL

Objective To establish the detection rate of prostate cancer recurrence following definitive therapy by 18F-fluciclovine PET/computed tomography (CT) in patients with biochemical recurrence (BCR) and prostate-specific antigen (PSA) levels less than 2.00 ng/mL. Methods In this retrospective study, 78 patients with a PSA level of less than 2.00 ng/mL were selected from the 211 patients who underwent at least one 18F-fluciclovine PET/CT scan at our institution for the detection of biochemical recurrent prostate cancer between April 2017 and December 2018. Inherent differences in the characteristics of patients with and without a positive scan were investigated for possible associations using multivariable analysis. Results One or more positive sites of recurrence were identified in 44 out of 78 patients (56.4%). Patients with a Gleason score between 8 and 10 were more likely to have a positive scan compared to patients with Gleason scores of 6-7 [adjusted odds ratio: 3.53, 95% confidence interval (1.13-10.99), P = 0.03]. No other significant association was found between PSA, T classification, and detection rate. Conclusion 18F-fluciclovine PET/CT demonstrated a detection rate of 56.4% among patients with a PSA below 2.0 ng/mL. The results of this study support the use of 18F-fluciclovine PET/CT for the detection of recurrent prostate cancer at lower PSA levels, even at PSA levels less than 0.5 ng/mL.