Fluciclovine F18 (inravenous)

In order to detect any recurrence of prostate cancer in males, Fluciclovine F18 can be used with a PET scan to identify signs of recurrence.

Overview

Fluciclovine F18 is a radioactive diagnostic imaging agent which can be used to identify the recurrence of male prostate cancer, when used in conjunction with a PET scan. It is an injectable which must be delivered intravenously. Following prior treatment, if higher prostate-specific antigens are found in the blood, that is considered a positive test for recurrence of prostate cancer.

Since this is a radioactive drug, all necessary precautions must be observed during administration, both for medical personnel and for the patient. This includes the usage of appropriate gloves, shields, and even syringe shields throughout the process, so as to minimize the danger of radiation. Before being used, a vial of this drug must be closely inspected for discoloration and for the presence of any particles which might tend to degrade its effectiveness and to create a danger for the patient.

Patients should be advised to avoid strenuous exercise for the entire 24-hour period prior to administration and should avoid eating or drinking anything for at least four hours prior. An injection dosage of 5 mL is generally indicated, although this can be diluted with a sodium chloride injection of .9%. After injection, the treatment should be followed up with an intravenous flush of pure sodium chloride so as to confirm complete dosage delivery. Within three to five minutes after dosing, the PET scan can then begin.

Condition Treated

  • Used in positron emission tomography scans for prostate cancer

Type Of Medicine

  • Diagnostic imaging agent

Side Effects

While Fluciclovine F18 does provide some beneficial medical advantages, some patients will also experience side effects that vary widely in their degree of intensity. It is also possible for many patients to experience no side effects whatsoever, other than whatever discomfort is incurred during the PET scan procedure. One of the side effects which is to be most concerned about is the potential for an allergic reaction to this medication. Since you would only be receiving this drug in a clinical setting, medical personnel will always be on hand to observe the symptoms of an allergic reaction and can take all appropriate measures. In the immediate aftermath of being administered Fluciclovine F18, the signs to look for in an allergic reaction are as follows:

  • Sudden tightness in the chest
  • Abnormal weakness, fatigue, or overwhelming tiredness
  • Swelling or puffiness in the area of the face, especially in the eyelids, throat, tongue, or lips
  • Hives, skin rashes, and extreme itching
  • Fast or irregular heartbeat
  • Strong urge toward coughing
  • Difficulty with swallowing
  • Dizziness or lightheadedness.

There are also a number of side effects which may occur that are directly related to the injection site, and these can include any or all of the following:

  • Blisters
  • Peeling of the skin
  • Redness and inflammation
  • Tenderness or actual pain at the injection site.

Some patients have also reported experiencing a temporary loss of taste or a change of taste when eating or drinking in the hours following an injection of Fluciclovine F18, but these changes in taste have generally not lasted more than a day. There are various other minor side effects which some patients have reported, but these are also highly temporary in nature and will subside on their own without the need for any kind of medical treatment.

Dosage

The standard dosage for an adult patient who is about to undergo a PET scan is 5 ml to be administered directly into a vein. If deemed appropriate, the drug can be diluted with sodium chloride, but since it is radioactive, all cautions must be observed with handling and delivery so as not to endanger patient or medical people.

After Fluciclovine F18 has been administered to a patient, there should be an interval of between three and five minutes before the PET scan begins. At that time, the recommended approach would be to start a scan at the thighs, and proceed upward to the base of the skull. The patient should be encouraged to urinate frequently afterward, so as to flush out the radioactive agent as soon as possible.

Interactions

Fluciclovine F18 does not interact with other drugs, so there is no real danger of adverse effects accruing to the patient being scanned. Still, it is a good idea for a patient to provide his/her doctor with a full list of any other prescription drugs or over-the-counter medications being taken at the time. It is also worth mentioning about any significant level of smoking or alcohol drinking engaged in by the patient.

Warnings

There are a few warnings which patients and medical personnel should be aware of when Fluciclovine F18 is being administered to a patient prior to a PET scan. First and foremost, it should always be borne in mind that this is a radioactive drug, and all appropriate measures must be taken to safeguard both patient and all medical handlers involved in the procedure. The patient should be appropriately shielded, as should medical personnel, and any materials or equipment used during the process must also be shielded against radiation.

Injecting a patient with Fluciclovine F18 will contribute to that patient's cumulative exposure to radiation, and if a patient has been subjected to this or any similar procedure before, those will also contribute to the long-term radiation exposure sustained by a given patient. The reason this is important is that each instance of radiation exposure such as this can increase the risk of a patient developing some form of cancer. For that reason, this drug should only be administered when it is deemed necessary and urgent by a medical professional, and it is also the reason for extreme vigilance during all handling by healthcare providers.

There is a potential for various kinds of hypersensitive reactions by a patient including anaphylaxis, and since that is a possibility, there should always be emergency resuscitation equipment standing by, as well as qualified personnel to operate this equipment. If there happened to be some kind of hypersensitive reaction, valuable time would be lost in securing equipment and personnel to deal with the emergency, if it were not kept on hand and ready for use.

For medical personnel, the following cautions should be borne in mind:

  • The actual performance of this medication is definitely affected by levels of PSA
  • It is recommended to corroborate results with clinical correlation, specifically histopathological evaluation of the suspected body site of cancer recurrence
  • Interpretation errors of the imaging can occur, specifically when trace motions are involved. While results are usually informative and helpful, it still does not mean that a negative image rules out the possibility of recurrent prostate cancer, just as a positive result cannot definitively confirm the existence of recurrent prostate cancer.

Storage

Fluciclovine F18 should be stored at room temperature, ideally between 68 degrees Fahrenheit and 77 degrees Fahrenheit, although minor variations up or down are permissible, assuming these are temporary in nature. The drug contains no preservatives, so it will quickly degrade if these storage constraints are not observed faithfully. It is extremely important that this medication be kept stored in its original container, which will contain shielding against radiation. If you should observe any compromise in the container packaging itself, trained medical handlers should be called in to assess the situation, and take appropriate measures. This drug can only be issued to persons who have the proper licensing from the Nuclear Regulatory Commission, or the corresponding state-level authority in the location of usage.

Summary

Fluciclovine F18 is a radioactive imaging agent which is used in conjunction with positron emission tomography (PET) scans which can point to the possibility of recurrent prostate cancer in a given patient. Since it is radioactive, it must always be handled with the greatest care, and all appropriate safeguards should be observed, both for healthcare providers and for the patient to be scanned. This drug should only be used when it is deemed necessary by a qualified medical professional since it will contribute to a patient's cumulative radioactive profile, and that in turn can increase the risk of contracting some form of cancer.

The drug is delivered intravenously to a patient, and the patient must be advised against strenuous activity the day before, as well as against eating and drinking in the 4-hour period prior to injection. Even with these precautions being observed, there is a possibility of misinterpretation of scan results, or of inaccurate readings being taken from the scan. For this reason, it is highly recommended to corroborate results with other clinical tests that tend to either confirm or deny the scan results. Ideally, this drug should be used with scan results as just one component of a patient's testing for prostate cancer and should not constitute the sole basis for making a diagnosis of cancer.