Fluciclovine positron emission tomography in the setting of biochemical recurrence following local therapy of prostate cancer

Approximately one in five men will demonstrate biochemical recurrence (BCR) following local therapy for prostate cancer (PCa). Advanced imaging modalities including positron emission tomography (PET) imaging of various radiotracers have become more commonplace to visualize foci of disease recurrence. We performed a systematic review of the literature to describe current evidence in support of 18F-fluciclovine (Axumin) PET imaging in this clinical setting. An English literature search was conducted on PubMed/Medline for original investigations on 18F-fluciclovine PET for PCa. Boolean criteria included the terms: prostate, fluciclovine, FACBC and Axumin. Published articles meeting these criteria and their respective bibliographies and diagnostic modalities were included after review, when appropriate. Our literature review identified 93 articles. Among these, 18 met our inclusion criteria. Evidence suggests 18F-fluciclovine PET imaging is safe, well-tolerated and offers acceptable sensitivity and specificity for the detection of localized intraglandular and extraprostatic PCa foci in the setting of persistence or recurrence after primary treatment. Compared to other available PET radiotracers available, evidence suggests that 18F-fluciclovine may outperform ProstaScint and 11C-choline in this clinical setting. Furthermore, 18F-fluciclovine PET may aid guiding decision-making in regards to salvage therapy planning. Further investigation is warranted to validate these early findings and to further compare this agent to other available radiotracers in this setting.