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Top Line: The plenary session also included results (LBA 1) from the first trial randomizing patients to +/- fluciclovine PET in planning for salvage prostate radiation.

The Study: EMPIRE-1 included 165 enrollees post-radical prostatectomy with biochemical recurrence and negative re-staging bone scan and pelvic CT or MRI. Among those receiving restaging fluciclovine PET (n=79), over one-third had a change in planned radiation, with half of those planned for prostate-only treatment needing fields expanded to the pelvis and four forgoing salvage radiation altogether due to the revealing of gross extra-pelvic disease. Now here is where most imaging studies end. However, the ambitious primary aim of biochemical failure-free survival was actually significantly improved with re-staging fluciclovine PET as soon as 3 years: 63% without versus 76% with. The curves separated even further by 4 years when those rates were 51% versus still 76%. Importantly, areas of focal uptake did not receive additional boost doses in this trial but will in the follow-on trial EMPIRE-2.

TBL: Advanced prostate imaging may actually improve treatment outcomes among men receiving salvage radiation after prostatectomy. | Jani, ASTRO 2020

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