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• W3020404769 abstract "No AccessJournal of UrologyAdult Urology1 Oct 2020[18F]Fluciclovine Positron Emission Tomography/Computerized Tomography for Preoperative Staging in Patients with Intermediate to High Risk Primary Prostate Cancer Mehrdad Alemozaffar, Akinyemi A. Akintayo, Olayinka A. Abiodun-Ojo, Dattatraya Patil, Faisal Saeed, Yijian Huang, Adeboye O. Osunkoya, Mark M. Goodman, Martin Sanda, and David M. Schuster Mehrdad AlemozaffarMehrdad Alemozaffar Department of Urology, Emory University School of Medicine, Atlanta, Georgia Equal study contribution. More articles by this author , Akinyemi A. AkintayoAkinyemi A. Akintayo Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia Equal study contribution. Financial interest and/or other relationship with Blue Earth Diagnostics Ltd. and Nihon Medi-Physics Co., Ltd. through the Emory University Office of Sponsored Projects for other clinical trials using [18F]fluciclovine. More articles by this author , Olayinka A. Abiodun-OjoOlayinka A. Abiodun-Ojo Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia Financial interest and/or other relationship with Blue Earth Diagnostics Ltd. and Nihon Medi-Physics Co., Ltd. through the Emory University Office of Sponsored Projects for other clinical trials using [18F]fluciclovine. More articles by this author , Dattatraya PatilDattatraya Patil Department of Urology, Emory University School of Medicine, Atlanta, Georgia More articles by this author , Faisal SaeedFaisal Saeed Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia More articles by this author , Yijian HuangYijian Huang Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia More articles by this author , Adeboye O. OsunkoyaAdeboye O. Osunkoya Department of Urology, Emory University School of Medicine, Atlanta, Georgia Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia More articles by this author , Mark M. GoodmanMark M. Goodman Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia More articles by this author , Martin SandaMartin Sanda Department of Urology, Emory University School of Medicine, Atlanta, Georgia More articles by this author , and David M. SchusterDavid M. Schuster ‡Correspondence: Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Rd., Atlanta, Georgia 30322 telephone: 404-712-4859; FAX: 404-712-4860; E-mail Address: [email protected] Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia Financial interest and/or other relationship with Blue Earth Diagnostics Ltd., Nihon Medi-Physics Co., Ltd., Telix Pharmaceuticals (US) Inc., Advanced Accelerator Applications, FUJIFILM Pharamaceuticals USA, Inc., Syncona, Global Medical Solutions (Taiwan) and AIM Specialty Health. More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001095AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Accurate preoperative staging of prostate cancer is essential for treatment planning. Conventional imaging is limited in detection of metastases. Our primary aim was to determine if [18F]fluciclovine positron emission tomography/computerized tomography is an early indicator of subclinical metastasis among patients with high risk prostate cancer. Materials and Methods: A total of 68 patients with unfavorable intermediate to very high risk prostate cancer without systemic disease on conventional imaging were recruited before robotic radical prostatectomy with extended pelvic lymph node dissection. Diagnostic performance of [18F]fluciclovine positron emission tomography/computerized tomography and conventional imaging for detection of metastatic disease, and correlation of positivity to node and metastatic deposit size were determined. Results: Overall 57 of 68 patients completed the protocol, of whom 31 had nodal metastasis on histology. [18F]Fluciclovine positron emission tomography/computerized tomography sensitivity and specificity in detecting nodal metastasis was 55.3% and 84.8% per patient, and 54.8% and 96.4% per region (right and left pelvis, presacral and nonregional), respectively. Compared with conventional imaging [18F]Fluciclovine positron emission tomography/computerized tomography had significantly higher sensitivity on patient based (55.3% vs 33.3%, p <0.01) and region based (54.8% vs 19.4%, p <0.01) analysis, detecting metastasis in 7 more patients and 22 more regions, with similar high specificity. Four additional patients had distant disease or other cancer detected on [18F] fluciclovine positron emission tomography/computerized tomography which precluded surgery. Detection of metastasis was related to size of metastatic deposits within lymph nodes and overall metastatic burden. Conclusions: [18F]Fluciclovine positron emission tomography/computerized tomography detects occult metastases not identified on conventional imaging and may help guide treatment decisions and lymph node dissection due to high specificity for metastatic disease. References 1. : Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options. J Urol 2018; 199: 683. Link, Google Scholar 2. : EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 2017; 71: 618. Google Scholar 3. : The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 2008; 63: 387. 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A new proposal based on a two-institution experience on 703 consecutive N+ patients treated with radical prostatectomy, extended pelvic lymph node dissection and adjuvant therapy. Eur Urol 2009; 55: 261. Google Scholar 18. : Detection of pelvic lymph node metastases in patients with clinically localized prostate cancer: comparison of [18F]fluorocholine positron emission tomography-computerized tomography and laparoscopic radioisotope guided sentinel lymph node dissection. J Urol 2014; 176: 2006. Google Scholar 19. : Preoperative staging with 11C-choline PET/CT is adequately accurate in patients with very high-risk prostate cancer. Clin Genitourin Cancer 2018; 16: 305. Google Scholar 20. : Comparison between conventional imaging (abdominal-pelvic computed tomography and bone scan) and [18F]choline positron emission tomography/computed tomography imaging for the initial staging of patients with intermediate- tohigh-risk prostate cancer: a retrospective analysis. Scand J Urol 2015; 49: 345. Google Scholar 21. : [18F]fluoromethylcholine (FCH) positron emission tomography/computed tomography (PET/CT) for lymph node staging of prostate cancer: a prospective study of 210 patients. BJU Int 2012; 110: 1666. Google Scholar 22. : Preoperative staging of pelvic lymph nodes in prostate cancer by 11C-choline PET. J Nucl Med 2003; 44: 331. Google Scholar 23. : Diagnostic efficacy of 68Gallium-PSMA positron emission tomography compared to conventional imaging for lymph node staging of 130 consecutive patients with intermediate to high risk prostate cancer. J Urol 2016; 195: 1436. Link, Google Scholar 24. : Gallium 68 PSMA-11 PET/MR imaging in patients with intermediate- or high-risk prostate cancer. Radiology 2018; 288: 495. Google Scholar 25. : 68Ga-prostate specific membrane antigen (PSMA) positron emission tomography (PET) for primary staging of high-risk prostate cancer: a systematic review. World J Urol 2018; 36: 519. 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Google Scholar 30. : Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol 2002; 167: 1681. Link, Google Scholar Registered at ClinicalTrials.Gov: https://clinicaltrials.gov/ct2/show/NCT03081884. Supported by National Institutes of Health Grant U01-CA113913-11. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 204Issue 4October 2020Page: 734-740Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordslymph node excisionneoplasm stagingprostatic neoplasmsprostatectomyfluciclovine F-18AcknowledgmentsBridget Fielder, Almira Catic, Stephanie Giles, Fenton G. Ingram, Seraphinah Lawal, Ronald J. Crowe and the cyclotron/synthesis team from Emory University Center for Systems Imaging provided assistance. Blue Earth Diagnostics Ltd. provided fluciclovine synthesis cassettes to Emory University.MetricsAuthor Information Mehrdad Alemozaffar Department of Urology, Emory University School of Medicine, Atlanta, Georgia Equal study contribution. More articles by this author Akinyemi A. Akintayo Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia Equal study contribution. Financial interest and/or other relationship with Blue Earth Diagnostics Ltd. and Nihon Medi-Physics Co., Ltd. through the Emory University Office of Sponsored Projects for other clinical trials using [18F]fluciclovine. More articles by this author Olayinka A. Abiodun-Ojo Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia Financial interest and/or other relationship with Blue Earth Diagnostics Ltd. and Nihon Medi-Physics Co., Ltd. through the Emory University Office of Sponsored Projects for other clinical trials using [18F]fluciclovine. More articles by this author Dattatraya Patil Department of Urology, Emory University School of Medicine, Atlanta, Georgia More articles by this author Faisal Saeed Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia More articles by this author Yijian Huang Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia More articles by this author Adeboye O. Osunkoya Department of Urology, Emory University School of Medicine, Atlanta, Georgia Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia More articles by this author Mark M. Goodman Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia More articles by this author Martin Sanda Department of Urology, Emory University School of Medicine, Atlanta, Georgia More articles by this author David M. Schuster Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia ‡Correspondence: Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Rd., Atlanta, Georgia 30322 telephone: 404-712-4859; FAX: 404-712-4860; E-mail Address: [email protected] Financial interest and/or other relationship with Blue Earth Diagnostics Ltd., Nihon Medi-Physics Co., Ltd., Telix Pharmaceuticals (US) Inc., Advanced Accelerator Applications, FUJIFILM Pharamaceuticals USA, Inc., Syncona, Global Medical Solutions (Taiwan) and AIM Specialty Health. More articles by this author Expand All Registered at ClinicalTrials.Gov: https://clinicaltrials.gov/ct2/show/NCT03081884. Supported by National Institutes of Health Grant U01-CA113913-11. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement PDF downloadLoading ..." @default.
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