OBJECTIVE: To compare the diagnostic accuracy of whole-body bone scintigraphy with [99m Tc]-MDP (WBS), [18F]-sodium fluoride (NaF) PET/CT, and [18 F]-fluoromethylcholine (FCH) PET/CT using MRI as reference.
PATIENTS AND METHODS: Entry criteria were biopsy proven prostate cancer, a positive WBS consistent with bone metastases, and no history of androgen deprivation. Within 30 days after informed consent, trial scans were performed in random order. Scans were interpreted blindly for the purpose of a lesion-based analysis. The primary target variable was bone lesion (malignant / benign) and the gold standard was MRI
RESULTS: Fifty men were recruited between May 2009 and March 2012. Their mean age was 73 years, median PSA level was 84 ng/mL, and mean Gleason score was 7.7. Forty-six had all four scans, while four missed one PET/CT scan. A total of 526 bone lesions were found in the 50 men, 363 malignant and 163 non-malignant according to MRI. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were for WBS: 51%, 82%, 86%, 43% and 61%, for NaF-PET/CT: 93%, 54%, 82%, 78% and 81%, and for FCH-PET/CT: 85%, 91%, 95%, 75% and 87%, respectively.
CONCLUSIONS: FCH-PET/CT and NaF-PET/CT were superior to WBS with regard to detection of prostate cancer bone metastases within the spine. Our results question the use of WBS as the method of choice in hormone naïve prostate cancer patients.
Written by:
Poulsen MH, Petersen H, Høilund-Carlsen PF, Jakobsen JS, Gerke O, Karstoft J, Steffansen SI, Walter S. Are you the author?
Research Unit of Urology, Department of Urology, Odense University Hospital.
Reference: BJU Int. 2013 Dec 9. Epub ahead of print.
doi: 10.1111/bju.12599
PubMed Abstract
PMID: 24314065
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