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Am J Nucl Med Mol Imaging 2013;3(1):85-96

Original Article
Characterization of primary prostate carcinoma by
anti-1-amino-2-[18F] -fluorocyclobutane-1-carboxylic
acid (anti-3-[18F] FACBC) uptake

David M Schuster, Pooneh A Taleghani, Peter T Nieh, Viraj A Master, Rianot Amzat, Bital Savir-Baruch,
Raghuveer K Halkar, Tim Fox, Adeboye O Osunkoya, Carlos S Moreno, Jonathon A Nye, Weiping Yu,
Baowei Fei, Zhibo Wang, Zhengjia Chen, Mark M Goodman

Department of Radiology and Imaging Sciences, Emory University; Department of Urology, Emory University;
Department of Radiation Oncology, Emory University; Pathology and Laboratory Medicine, Emory University;
Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA

Received October 7, 2012; Accepted December 10, 2012; Epub January 5, 2013; Published January 15, 2013

Abstract: Anti-1-amino-3-[18F] fluorocyclobutane-1-carboxylic acid (anti-3-[18F] FACBC) is a synthetic amino acid positron
emission tomography (PET) radiotracer with utility in the detection of recurrent prostate carcinoma. The aim
of this study is to correlate uptake of anti-3-[18F] FACBC with histology of prostatectomy specimens in patients
undergoing radical prostatectomy and to determine if uptake correlates to markers of tumor aggressiveness such
as Gleason score. Ten patients with prostate carcinoma pre-radical prostatectomy underwent 45 minute dynamic
PET-CT of the pelvis after IV injection of 347.8 ± 81.4 MBq anti-3-[18F] FACBC. Each prostate was co-registered to a
separately acquired MR, divided into 12 sextants, and analyzed visually for abnormal focal uptake at 4, 16, 28, and
40 min post-injection by a single reader blinded to histology. SUVmax per sextant and total sextant activity (TSA) was
also calculated. Histology and Gleason scores were similarly recorded by a urologic pathologist blinded to imaging.
Imaging and histologic analysis were then compared. In addition, 3 representative sextants from each prostate were
chosen based on highest, lowest and median SUVmax for immunohistochemical (IHC) analysis of Ki67, synaptophysin,
P504s, chromogranin A, P53, androgen receptor, and prostein. 79 sextants had malignancy and 41 were
benign. Highest combined sensitivity and specificity was at 28 min by visual analysis; 81.3% and 50.0% respectively.
SUVmax was significantly higher (p<0.05) for malignant sextants (5.1±2.6 at 4 min; 4.5±1.6 at 16 min; 4.0±1.3 at
28 min; 3.8±1.0 at 40 min) compared to non-malignant sextants (4.0±1.9 at 4 min; 3.5±0.8 at 16 min; 3.4±0.9 at
28 min; 3.3±0.9 at 40 min), though there was overlap of activity between malignant and non-malignant sextants.
SUVmax also significantly correlated (p<0.05) with Gleason score at all time points (r=0.28 at 4 min; r=0.42 at 16
min; r=0.46 at 28 min; r=0.48 at 40 min). There was no significant correlation of anti-3-[18F] FACBC SUVmax with Ki-
67 or other IHC markers. Since there was no distinct separation between malignant and non-malignant sextants or
between Gleason score levels, we believe that anti-3-[18F] FACBC PET should not be used alone for radiation therapy
planning but may be useful to guide biopsy to the most aggressive lesion. (ajnmmi1210001).

Keywords: Positron emission tomography (PET), prostate carcinoma, anti-3-[18F] FACBC

Address all correspondence to:
Dr. David M Schuster
Division of Nuclear Medicine and Molecular Imaging
Department of Radiology and Imaging Sciences
Emory University Hospital, Room E152, 1364 Clifton Road
Atlanta, GA 30322, USA.
Phone: 404-7124859; Fax: 404-7124860
E-mail: dschust@emory.edu