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.