[18F]fluciclovine vs. [18F]fluorocholine Positron Emission Tomography/Computed Tomography: A Head-to-Head Comparison for Early Detection of Biochemical Recurrence in Prostate Cancer Patients
, Paolo Mammucci 1, Valentina Lavelli 1, Antonio Rosario Pisani 1, Anna Giulia Nappi 1, Dino Rubini 1, Angela Sardaro 2,* and Giuseppe Rubini 1
Won Woo Lee
Round 1
Reviewer 1 Report
The paper seems to be well-designed and the results are solid.
The merit of synthetic amino acid derivatie (leucine-derivative) for BCR of prosate cancer is straight-forward because urine activity is minimal, which is well represented by the higher detection rate of F-18 fluciclovine PET/CT compared to F-18 fluorocholine PET/CT.
I have little arugment of the paper except one issue. The authors randomized the patient group but details are lacking. Please explain how the randomization was performed.
The end.
Author Response
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Author Response File: 
Author Response.pdf
Reviewer 2 Report
This study has conducted a medium-scale head to head comparison between two approved 18F-labelled PET/CT reagents in prostate cancer relapse detection and suggested an overall better diagnostic performance of [18F]Fluciclovine compared to [18F]Fluorocholine PET/CT.
The study has solid relevance to current prostate cancer management and could benefit patients in selecting a more sensitive and selective reagents to monitor their post-treatment status.
The authors also clearly address the limitations of the current study, which will not impair the scientific significance of the conclusion, but further strengthen the rationale of performing such head to head comparison for patients' benefits.
While the paper is well-organized and neatly designed, there are still a few more points to be improved.
1. It should be noted that patients in the two groups may have different tracer metabolism dynamics since [18F]Fluciclovine and [18F]Fluorocholine PET/CT were applied to different groups of patients. While it may be challenging to apply the two PET/CT on the same patient, some discussion about this limitations should be included and highlighted.
2. The the interpretation of PET/CT DR results could be further elaborated. For example, how does the PET/CT DR of the two reagents correlate to the absolute PSA level, or the absolute PSA increase amount â–³PSA? How does the total positive PET/CT scan signals, instead of simple 0/1 DR correlate to PSA level or PSAdt?
3. The authors discussed that PSMA is a priority choice in the clinical practice while there are still PSMA-negative patients. A few more references are needed here (line 439/440).
Author Response
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Author Response File: Author Response.pdf
