Incidental Detection of Lung Adenocarcinoma Presenting as an Anterior Mediastinal Mass on 18F-Fluciclovine PET/CT in a Patient With Primary Prostate Cancer.
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ABSTRACT:
SUBMITTER: Abiodun-Ojo OA
PROVIDER: S-EPMC7609453 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
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Incidental Detection of Lung Adenocarcinoma Presenting as an Anterior Mediastinal Mass on 18F-Fluciclovine PET/CT in a Patient With Primary Prostate Cancer.
Abiodun-Ojo Olayinka A OA Akintayo Akinyemi A AA Sica Gabriel L GL Alemozaffar Mehrdad M Schuster David M DM
Clinical nuclear medicine 20201201 12
F-fluciclovine is a PET radiotracer approved for detection of recurrent prostate cancer, with utility in other malignancies being investigated. We present the case of a 71-year-old man with high-risk primary prostate cancer (Gleason score 9, prostate-specific antigen 34 ng/mL) and newly diagnosed lung adenocarcinoma. As part of a clinical trial (NCT03081884), preoperative F-fluciclovine PET/CT showed localized abnormal uptake in the prostate gland with extracapsular extension. Additionally, an i ...[more]
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Project description:The primary aim of the study was to evaluate the role of [18F]Fluciclovine PET/CT in the characterization of intra-prostatic lesions in high-risk primary PCa patients eligible for radical prostatectomy, in comparison with conventional [11C]Choline PET/CT and validated by prostatectomy pathologic examination. Secondary aims were to determine the performance of PET semi-quantitative parameters (SUVmax; target-to-background ratios [TBRs], using abdominal aorta, bone marrow and liver as backgrounds) for malignant lesion detection (and best cut-off values) and to search predictive factors of malignancy. A six sextants prostate template was created and used by PET readers and pathologists for data comparison and validation. PET visual and semi-quantitative analyses were performed: for instance, patient-based, blinded to histopathology; subsequently lesion-based, un-blinded, according to the pathology reference template. Among 19 patients included (mean age 63 years, 89% high and 11% very-high-risk, mean PSA 9.15 ng/mL), 45 malignant and 31 benign lesions were found and 19 healthy areas were selected (n = 95). For both tracers, the location of the "blinded" prostate SUVmax matched with the lobe of the lesion with the highest pGS in 17/19 cases (89%). There was direct correlation between [18F]Fluciclovine uptake values and pISUP. Overall, lesion-based (n = 95), the performance of PET semiquantitative parameters, with either [18F]Fluciclovine or [11C]Choline, in detecting either malignant/ISUP2-5/ISUP4-5 PCa lesions, was moderate and similar (AUCs ≥ 0.70) but still inadequate (AUCs ≤ 0.81) as a standalone staging procedure. A [18F]Fluciclovine TBR-L3 ≥ 1.5 would depict a clinical significant lesion with a sensitivity and specificity of 85% and 68% respectively; whereas a SUVmax cut-off value of 4 would be able to identify a ISUP 4-5 lesion in all cases (sensitivity 100%), although with low specificity (52%). TBRs (especially with threshold significantly higher than aorta and slightly higher than bone marrow), may be complementary to implement malignancy targeting.
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Project description:BackgroundProstate cancer is highly prevalent worldwide. Androgen deprivation therapy (ADT) remains the treatment of choice for incurable prostate cancer, but majority of patients develop disease recurrence following ADT. There is therefore an urgent need for early detection of treatment resistance.MethodsIsogenic androgen-responsive (CWR22Res) and castration-resistant (22Rv1) human prostate cancer cells were implanted into the anterior lobes of the prostate in CD-1 Nu mice to generate prostate orthografts. Castrated mice bearing CWR22Res and 22Rv1 orthografts mimic clinical prostate cancer following acute and chronic ADT, respectively. 18F-Fluciclovine (1-amino-3-fluorocyclobutane-1-carboxylic acid) with a radiochemical purity of > 99% was produced on a FASTlab synthesiser. Ki67 staining in endpoint orthografts was studied. Western blot, quantitative RT-PCR and next-generation sequencing transcriptomic analyses were performed to assess the expression levels of amino acid transporters (including LAT1 and ASCT2, which have been implicated for Fluciclovine uptake). Longitudinal metabolic imaging with 18F-Fluciclovine-based positron emission tomography (PET) was performed to study tumour response following acute and chronic ADT.ResultsBoth immunohistochemistry analysis of endpoint prostate tumours and longitudinal 18F-Fluciclovine imaging revealed tumour heterogeneity, particularly following ADT, with in vivo 18F-Fluciclovine uptake correlating to viable cancer cells in both androgen-proficient and castrated environment. Highlighting tumour subpopulation following ADT, both SUVpeak and coefficient of variation (CoV) values of 18F-Fluciclovine uptake are consistent with tumour heterogeneity revealed by immunohistochemistry. We studied the expression of amino acid transporters (AATs) for 18F-Fluciclovine, namely LAT1 (SLC7A5 and SLC3A2) and ASCT2 (SLC1A5). SLC7A5 and SLC3A2 were expressed at relatively high levels in 22Rv1 castration-resistant orthografts following chronic ADT (modelling clinical castration-resistant disease), while SLC1A5 was preferentially expression in CWR22Res tumours following acute ADT. Additional AATs such as SLC43A2 (LAT4) were shown to be upregulated following chronic ADT by transcriptomic analysis; their role in Fluciclovine uptake warrants investigation.ConclusionWe studied in vivo 18F-Fluciclovine uptake in human prostate cancer orthograft models following acute and chronic ADT. 18F-Fluciclovine uptakes highlight tumour heterogeneity that may explain castration resistance and can be exploited as a clinical biomarker.
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Project description:PurposeF-fluciclovine is a synthetic amino acid radiotracer that has recently been approved in Europe and the United States for PET imaging in men with biochemical recurrence (BCR) of prostate cancer after prior definitive treatment. Accurate identification of the sites of disease in patients presenting with BCR of prostate cancer is important in determining the appropriate treatment. Bone is the most frequent site of metastatic disease in patients with prostate cancer.MethodsWe conducted a comprehensive review of the available preclinical and clinical data on the diagnostic performance of F-fluciclovine PET/CT in an attempt to draw practical and general conclusions on the utility and limitations of F-fluciclovine PET/CT in localization of osseous metastatic disease in prostate cancer.ResultsThe cumulative preclinical data and results of some retrospective and 2 prospective clinical studies suggest that F-fluciclovine can detect early bone marrow involvement in patients with BCR of prostate cancer and negative prior bone-specific imaging findings.ConclusionsF-fluciclovine PET/CT seems to offer useful information for early detection of bone metastases in men with BCR of prostate cancer. Additional investigations will be needed to compare the diagnostic performance of F-fluciclovine PET/CT to other standard and novel imaging methods in initial staging, BCR, and castrate-resistant phases of disease.
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Project description:PurposeAlthough 18 F-FDG-PET/CT is helpful in defining many types of cancer, localized prostate cancer should not be treated with this technique. This study describes the use of multi-parametric MRI (mpMRI) to characterize incidental 18 F-FDG uptake in the prostate.Methods and materialsWhile 18 F-FDG-PET/CT is useful for characterizing a variety of cancers, it is not advised for prostate cancer that is localized. This work investigates the use of mpMRI to describe incidental 18 F-FDG uptake in the prostate.mpMRI included T2-weighted (T2W), dynamic contrast enhancement (DCE), and apparent diffusion coefficient (ADC) sequences. Patients were classified according to PI-RADS (Prostate Imaging Reporting and Data System) version 2.1 by an experienced uroradiologist, and 18 F-FDG-PET was evaluated to determine whether the area of involvement on CT had a counterpart in mpMRI. A biopsy was performed on 30 of the 92 patients. These patients' maximum standardized uptake values (SUVmax) 6 < and ≥ 6, PS(PSA) density 0.15 < and ≥ 0.15, PSA level, uptake pattern (focal involvement/diffuse involvement), and PI-RADS scores were compared. P < .05 was considered statistically significant. Logistic regression was used to analyze PI-RADS score groups age, PSA, PSA density and SUVmax.ResultsIn the study, 92 patients with incidental 18 F-FDG-PET/CT prostate uptake were examined. Median age was 66, PSA median was 3.6 ng/ml (range: 0-3198 ng/ml). Notably, in 70.6% of cases, PET/CT uptake didn't correlate with mp-MRI findings. Among PI-RADS 3-4-5 patients (29.3%), there was a correlation. Biopsies in 30 patients revealed 43.3% benign, 56.7% malignant. Significant differences between benign and malignant cases were observed in PSA density, PI-RADS scores, and PSA levels (p < .05), while SUVmax and uptake pattern were not significant. In multivariate logistic regression analysis, PI-RADS score groups were found to be independent risk factors for predicting malignancy.ConclusionsOur study showed that incidental 18 F-FDG-PET/CT prostate uptake was detected and that high PSA density values, PI-RADS scores, and PSA values, such as in routine patients, and not PET-CT findings such as SUVmax and uptake pattern, were more predictive of malignancy.
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