Bone metastases from prostate cancer: Head-to-head comparison of 99mTc-MDP scintigraphy, 18F-fluorocholine PET/CT, and 18F-fluoride PET/CT

Objectives For years, whole body (WB) bone scintigraphy with 99mTc-MDP was the method of choice for the detection of bone metastases from prostate cancer. However, with time it has become increasingly clear that the diagnostic accuracy of bone scintigraphy may be inferior to that of PET in this disease. To elucidate this we made a head-to-head comparison of (a) 99mTc-MDP WB bone scintigraphy, (b) 18F-choline PET/CT, and (c) 18F-fluoride PET/CT using MRI as reference.

Methods We included prospectively 42 patients with histologically confirmed prostate cancer, no androgen deprivation, and bone metastasis according to 99mTc-MDP WB bone scintigraphy. The four examinations were performed in random order within a maximum of 4 weeks. All scans were interpreted blindly for the purpose of this per lesion analysis. All patients gave informed consent and the study was approved by the local ethics committee.

Results Mean patient age was 73 years (range 53-92), median PSA level was 77 (range 4-5740), average Gleason score was 7.6 (range 2-10). A total of 431 bone lesions were found in the 42 patients, 283 were malignant according to MRI. Results (with 95% CI in parentheses) are given in the Table.

Conclusions 18F-choline PET/CT appears to be superior to 18F-fluoride PET/CT and 99mTc-MDP WB bone scintigraphy with regard to detection of prostate cancer metastases. These findings question the use of 99mTc-MDP bone scintigraphy, although less expensive, as the method of choice in hormone naive patients with prostate cancer. Until further, 18F-choline PET/CT may be preferable

• Download figure
• Open in new tab
• Download powerpoint

Diagnostic performance of the three modalities vs MRI