Axumin Positron Emission Tomography: Novel Agent for Prostate Cancer Biochemical Recurrence

Swachchhanda Songmen, Pankaj Nepal, Thomas Olsavsky, Joshua Sapire, Swachchhanda Songmen, Pankaj Nepal, Thomas Olsavsky, Joshua Sapire

Abstract

Prostate cancer remains one of the top common cancers in terms of incidence and cancer-related deaths. Approximately 1/3rd cases develop biochemical recurrence during surveillance post-definite therapy. Multiple imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI) (including multiparametric prostate MRI), bone scan, and positron emission tomography (PET) using different tracers are being used for the characterization of the prostate cancer recurrence. CT and MRI do not provide physiological information, thus have lower sensitivity in detecting the metastasis. A bone scan has low sensitivity (depending on the prostate-specific antigen level) with low specificity as well. Among different PET tracers, Axumin PET appears to be the most promising tool. Axumin PET is Food and Drug Administration approved for the evaluation of prostate cancer biochemical recurrence. Several studies have shown that Axumin PET findings played a key role in treatment modification by finding otherwise undetected lesions. We briefly discuss the salient characteristics, imaging protocol and image interpretation criteria for Axumin PET in the workup of prostate cancer biochemical recurrence.

Keywords: Axumin (18F-fluciclovine); Biochemical recurrence; Positron emission tomography; Prostate cancer; Prostate-specific antigen.

Conflict of interest statement

There are no conflicts of interest.

© 2019 Published by Scientific Scholar on behalf of Journal of Clinical Imaging Science.

Figures

Figure 1:
Figure 1:
An 85-year-old male with history of prostate cancer status post radiation treatment presented with rising prostate- specific antigen level of 6.1 ng/mL. (a) Axumin positron emission tomography-computed tomography axial image showing increased radiotracer uptake (standardized uptake value maximum of 5.3) in the left internal iliac lymph node (yellow arrow). (b) Magnetic resonance imaging pelvis T1 weighted axial image depicting a few enlarged bilateral internal iliac lymph nodes (red arrow) which were otherwise inconclusive for recurrence.
Figure 2:
Figure 2:
A 76-year-old male with history of prostate cancer status post brachytherapy with rising prostate-specific antigen level of 6.4 ng/mL. (a) Axumin positron emission tomography-computed tomography (CT) axial image showing focal asymmetric tracer activity in the prostate with standardized uptake value maximum (SUVmax) 2.1 (yellow arrow) in contrast to marrow activity (SUVmax 1.4). (b) Non-contrast CT of pelvis for radiation planning axial image showing brachytherapy seeds but no visible mass (red arrow).
Figure 3:
Figure 3:
An 88-year-old male with history of prostate cancer status post prostatectomy presented with progressive back pain and prostate- specific antigen level of 6.9 ng/mL concerning for recurrence. (a) Bone scan was negative. (b) Axumin positron emission tomography- computed tomography axial image demonstrating intense tracer uptake (standardized uptake value maximum 6.4) in the left posterolateral aspect of the T8 vertebral body (red arrow). (c) Pre-biopsy magnetic resonance imaging performed showing T2 hypointense lesion (yellow arrow) measuring 2.2 cm which was consistent with osteoblastic metastasis on biopsy.

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