PET/CT Fluciclovine F18 (Axumin) Scan for Prostate Cancer Recurrence

Hybrid Positron Emission and Computer Tomography (PET/CT) Axumin is an imaging technique for detecting biochemical recurrence of prostate cancer after definitive therapy.

Prostate cancer is one of the top-ranking malignancies in terms of incidence and cancer-related mortality. After definite treatment, approximately one third of patients develop recurrence detected by rising prostate-specific antigen (PSA) level.

Accurate characterization of the recurrence is pivotal in planning further management. Multiple imaging modalities including MRI of the pelvis and a CT of the abdomen and pelvis with contrast have limitations in accurately depicting the disease extent. A traditional bone scan is also not able to detect the tumor proliferation in the soft tissue (prostate bed, lymph nodes). A novel positron emission tomography (PET) tracer using 18F-fluciclovine (Axumin), is approved by the Food and Drug Administration (FDA) for workup of the prostate cancer biochemical recurrence.

How PET/CT Axumin Scan Works

The Axumin is injected while the patient is lying on the scanner and the images are obtained approximately 3 to 5 minutes post-injection. After the injection, Axumin travels into cancer cells—including prostate cancer cells—and lights up in the PET/CT scan. An imaging physician will review your scan to find out where the recurrent prostate cancer is located.

Why Choose Charter Radiology?

Our advanced 128-slice Biograph mCT PET/CT may detect the early recurrence of prostate cancer before it is visualized on traditional modalities such as X-ray, CT, bone scan, or MRI, which has made a significant clinical impact.

Case Study

A 78-year-old male with a history of prostate cancer presented with an elevated PSA.

Figure. PET/CT Axumin scan showed multiple focal areas of tracer activity in the spine and pelvic bones without underlying sclerotic lesions on the CT scan, representing new developing osseous metastasis.

CHARTER RADIOLOGY where care starts at the molecular level with our state-of-the-art 128-slice PET/CT Biograph mCT.

Advanced Technology

We offer the most advanced imaging with precision and accuracy. With the help of artificial intelligence, we provide faster workforce productivity (automatically generate and export PACS-ready images), two times faster scans or half the injected dose without compromising image quality.


A large 78 cm bore, short 135 cm tunnel and 227 kg (500 lb) table capacity supports the examination of a heavier patient population (including bariatric), allowing for easier patient positioning and patient comfort.

Speed and Quality

Our LSO crystal is faster and has a higher light output, enabling better image quality with higher spatial resolution and lesion visualization.

Lowest radiation dose

Definition 128 AS scanner with Safire detectors reduces radiation

doses by 60-80%.

Is PET/CT Axumin safe?

A typically administered activity (dose) of 370 MBq (approximately 8 mSV or 10mCi) is relatively low (compare to a regular CT scan radiation dose 7 mSV without contrast and >15 mSV with contrast).

PET/CT with Axumin Imaging – What to Expect

  • Avoid any significant exercise for at least a full 24 hours prior to your scan.
  • Do not eat or drink for at least 4 hours before your PET/CT scan.
  • Our nuclear technologist will inject painless radiotracer IV (intravenous). Once Axumin has been given, more saline will be put in the IV to ensure you received the full dose Axumin dose for your scan.
  • The PET/CT scan will begin approximately 3 to 5 minutes after completion.
  • You will be moved to the PET/CT scanner. The average scanning time is about 15 to 20 minutes.
  • When the test is complete, you may resume your normal activities.
  • The radiotracer will pass through your body through urine and natural radioactive decay.
  • We encourage you to drink plenty of water after the test.


While conventional imaging establishes the presence of solitary pulmonary nodules (SPNs), invasive procedures that involve risk may be required to characterize the lesions.

PET/CT utilization as a diagnostic tool could reduce the number of unnecessary biopsies or thoracotomies on benign SPNs. Nodules that were classified as indeterminate on CT were correctly characterized on PET in over 80% of the cases.

PET should be obtained in the diagnostic work-up of patients with SPN.

PET enables the physician to make a more informed clinical decision. 

The American College of Chest Physicians recommends: In patients with a low-to-moderate pretest probability of malignancy (5% to 65%) and an indeterminate SPN that measures at least 8 mm in diameter, we suggest that functional imaging, preferably with positron emission tomography (PET), should be performed to characterize the nodule.

Medicare recognizes the utility of PET and PET/CT in solitary pulmonary nodule (SPN).

Initial Treatment Strategy

Medicare covers PET scans for characterization of a single pulmonary nodule under the Initial Treatment Strategy of Lung Cancer. For the Initial Treatment Strategy, PET/CT may be used:

  • To determine whether or not the beneficiary is an appropriate candidate for an invasive diagnostic or therapeutic procedure
  • To determine the optimal anatomic location for an invasive procedure

To determine the anatomic extent of the tumor when the recommended anti-tumor treatment reasonably depends on the extent of the tumor.

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) Center of Excellence PET PROS Diagnosis of Pulmonary Nodules:

  • PET and PET/CT are approved by the Centers for Medicare and Medicaid Services (CMS) for the characterization of solitary pulmonary nodules not exceeding 4 cm to determine the likelihood of malignancy. Claims should include evidence of the initial detection of a primary lung nodule, usually by computed tomography.
  • The U.S. Preventive Services Task Force (USPSTF) recently released an updated, final recommendation for CT lung cancer screening that lowers the starting age from 55 to 50 years and adjusts smoking history from 30 pack years to 20 pack years.