This prospective pilot study evaluated the ability of sodium fluoride (Na(18)F) positron emission tomography/computed tomography (NaF-PET/CT) to detect and monitor bone metastases over time and its correlation with clinical outcomes and survival in advanced prostate cancer.
PATIENTS AND METHODS - Sixty prostate cancer patients, including 30 with and 30 without known bone metastases by conventional imaging underwent NaF-PET/CT at baseline, 6, and 12 months. Positive lesions were verified on follow-up scans. Changes in standardized uptake values (SUV) and lesion number were correlated with prostate-specific antigen (PSA) change, clinical impression, and overall survival (OS).
RESULTS - Sixty patients underwent 170 NaF-PET/CT scans. Significant associations included SUV and PSA percent change at 6 (P = 0. 014) and 12 months (P = 0. 0005); SUV maximal percent change from baseline and clinical impression at 6 months (P = 0. 0147) and 6-12 months (P = 0. 0053); SUV change at 6 months and OS (P = 0. 018); number of lesions on NaF-PET/CT and clinical impression at baseline (P < 0. 0001), 6 (P = 0. 0078), and 12 months (P = 0. 0029); number of lesions on NaF-PET/CT per patient at baseline and OS (P = 0. 017). In an exploratory analysis, paired (99m)Tc-MDP bone scans (TcBS) were available in 35 patients at baseline, 19 at 6 months, and 14 at 12 months (n = 68 scans). Malignant lesions on NaF-PET/CT (n =57) were classified on TcBS as malignant 65%; indeterminate 25%; and negative 10%. Additionally 65% of paired scans showed more lesions on NaF-PET/CT than on TcBS.
CONCLUSIONS - Baseline number of malignant lesions and changes in SUV on follow-up NaF-PET/CT significantly correlates with clinical impression and OS. NaF-PET/CT detects more bone metastases earlier than TcBS and enhances detection of new bone disease in high-risk patients.
Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2016 Jan 21 [Epub ahead of print]
Andrea B Apolo, Liza Lindenberg, Joanna H Shih, Esther Mena, Joseph W Kim, Jong C Park, Anna Alikhani, Yolanda Y McKinney, Juanita Weaver, Baris Turkbey, Howard L Parnes, Lauren V Wood, Ravi A Madan, James L Gulley, William L Dahut, Karen A Kurdziel, Peter L Choyke
National Cancer Institute, United States;, National Cancer Institute, United States;, National Cancer Institute, United States;, National Cancer Institute, United States; National Cancer Institute, United States;, National Cancer Institute, United States;, National Cancer Institute, United States;, National Cancer Institute, United States;, National Cancer Institute, United States;, National Cancer Institute, United States;, National Cancer Institute, United States;, National Cancer Institute, United States;, National Cancer Institute, United States;, National Cancer Institute, United States;, National Cancer Institute, United States;