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Comparing Imaging Modalities After Prostatectomy to Guide Radiotherapy Decision-Making

By: Cordi Craig, MS
Posted: Wednesday, July 21, 2021

Clinical management continues to improve for patients who experience disease progression or fail to achieve adequate responses following prostatectomy. According to the results of the phase II/III EMPIRE-1 trial, published in The Lancet, the inclusion of the radiotracer 18F-fluciclovine–positron-emission tomography (PET) into radiotherapy decision-making may significantly improve disease-free survival rates among men who have undergone prostatectomy. The study group concluded that integrating novel PET radiotracers into radiotherapy decisions warrants further study for men with prostate cancer.

“We have a proof-of-concept of how molecular imaging can not only actually improve our ability to find cancer, but also improve outcomes,” David M. Schuster, MD, of Emory University, Atlanta, stated in a press release.

From September 2012 to March 2019, the research team randomly assigned 165 patients with prostate cancer and detectable prostate-specific antigen after prostatectomy and negative conventional imaging to radiotherapy with conventional imaging alone (n = 81) or conventional imaging plus 18F-fluciclovine-PET/computed tomography (n = 76). Events were defined as disease recurrence or progression or initiation of systemic therapy. The median follow-up was 3.5 years.

Median survival was not reached in either group. Events were reported in 33% of patients treated with conventional imaging versus 20% of patients treated with fluciclovine PET. The results revealed that 63% of patients who received conventional imaging were disease-free after 3 years compared with 75.5% of patients in the fluciclovine-PET imaging group (P = .0028). In further analyses, the study group was associated with event-free survival (P = .03).

The researchers observed similar toxicity profiles among the two groups. The most common adverse event was late urinary frequency or urgency and acute diarrhea. Grade 3 toxic events were rare, and no patients reported severe adverse events.

Disclosure: For full disclosures of the study authors, visit thelancet.com.



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