FACBC Outcomes for Post Prostatectomy
| Status: | Recruiting |
|---|---|
| Conditions: | Prostate Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - 95 |
| Updated: | 4/3/2019 |
| Start Date: | September 2012 |
| End Date: | April 30, 2019 |
| Contact: | Ashesh B Jani, MD, MSEE |
| Email: | abjani@emory.edu |
| Phone: | 404-778-3827 |
Advanced Molecular Imaging With Anti-3-[18F]FACBC PET-CT to Improve the Selection and Outcomes of Prostate Cancer Patients Receiving Post-prostatectomy Radiotherapy
Prostate cancer is the most common solid tumor, with approximately 200,000 new cases
diagnosed per year. Several different local therapies are available for treatment, including
surgery and radiotherapy Significant advances have been made in the technical aspects of
surgery and of radiotherapy which have improved both the cancer control outcomes as well as
the morbidity of treatment. Despite these significant advances, approximately 30% of patients
treated with definitive local therapy experience recurrent disease. Recurrent disease after
prostatectomy usually manifests with rising PSA (blood test for prostate cancer). The PSA
level is often of limited use in differentiating local recurrence (ie. recurrence in the
prostate bed) from recurrence outside of the prostate bed ( extra-prostatic recurrence).
One PET radiotracer which has shown promise in the staging and restaging of patients with
prostate carcinoma is anti-1-amino-3-[18F]fluorocyclobutane-1-carboxylic acid
(anti-3-[18F]FACBC) which is a synthetic amino acid analog. FACBC demonstrated higher
accuracy compared with 111Indium-capromab-pendetide in the restaging of patients with
suspected recurrent prostate carcinoma.
The major goal in this proposed investigation is to use advanced molecular imaging to better
guide post-prostatectomy decision making, in terms of guiding the decision to deliver
radiotherapy, and in terms of the exact areas treated with radiotherapy.
Investigators will perform a study with 162 patients in whom there is a strong suspicion of
prostate cancer that has returned to the body after having a prostatectomy. Half of these
patients will have radiotherapy decision-making and delivery per the usual routine, and half
of these patients will have the radiotherapy decision and volumes guided by the FACBC test.
The major goal of the investigation is to see whether the FACBC improves the selection and
the cancer control rates of post-surgery patients with a rising PSA who undergo radiotherapy.
diagnosed per year. Several different local therapies are available for treatment, including
surgery and radiotherapy Significant advances have been made in the technical aspects of
surgery and of radiotherapy which have improved both the cancer control outcomes as well as
the morbidity of treatment. Despite these significant advances, approximately 30% of patients
treated with definitive local therapy experience recurrent disease. Recurrent disease after
prostatectomy usually manifests with rising PSA (blood test for prostate cancer). The PSA
level is often of limited use in differentiating local recurrence (ie. recurrence in the
prostate bed) from recurrence outside of the prostate bed ( extra-prostatic recurrence).
One PET radiotracer which has shown promise in the staging and restaging of patients with
prostate carcinoma is anti-1-amino-3-[18F]fluorocyclobutane-1-carboxylic acid
(anti-3-[18F]FACBC) which is a synthetic amino acid analog. FACBC demonstrated higher
accuracy compared with 111Indium-capromab-pendetide in the restaging of patients with
suspected recurrent prostate carcinoma.
The major goal in this proposed investigation is to use advanced molecular imaging to better
guide post-prostatectomy decision making, in terms of guiding the decision to deliver
radiotherapy, and in terms of the exact areas treated with radiotherapy.
Investigators will perform a study with 162 patients in whom there is a strong suspicion of
prostate cancer that has returned to the body after having a prostatectomy. Half of these
patients will have radiotherapy decision-making and delivery per the usual routine, and half
of these patients will have the radiotherapy decision and volumes guided by the FACBC test.
The major goal of the investigation is to see whether the FACBC improves the selection and
the cancer control rates of post-surgery patients with a rising PSA who undergo radiotherapy.
Inclusion Criteria:
- Adenocarcinoma of the prostate, post radical-prostatectomy Detectable PSA
- ECOG/Zubrod Performance Status of 0-2
- Negative technetium 99-m MDP or F-18 PET bone scan for skeletal metastasis
- CT or MR scan of abdomen and pelvis which does not suggest presence of metastatic
disease outside of the pelvis
- Willingness to undergo pelvic radiotherapy.
Exclusion Criteria:
- Contraindications to radiotherapy (including active inflammatory bowel disease or
prior pelvic XRT)
- Inability to undergo anti-3-[18F]FACBC PET-CT
- Age under 18
- Metastatic disease outside of pelvis on any imaging or biopsy
- Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free
for a minimum of 3 years
- Severe acute co-morbidity, defined as follows:
- Unstable angina and/or congestive heart failure requiring hospitalization in the
last 3 months
- Transmural myocardial infarction within the last 6 months
- Acute bacterial or fungal infection requiring intravenous antibiotics at the time
of registration
- Chronic Obstructive Pulmonary Disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy at the time of registration
- Acquired Immune Deficiency Syndrome (AIDS) based upon current CDC definition;
note, however, that HIV testing is not required for entry into this protocol. The
need to exclude patients with AIDS from this protocol is necessary because the
treatments involved in this protocol may be significantly immunosuppressive.
Protocol-specific requirements may also exclude immunocompromised patients
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