Abstract
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Objectives Identify an effective alternative method to stage and restage patients with prostate cancer using a combination of 18F-FDG and 18F-NaF in a single exam.
Methods There were 15 patients with history of prostate cancer with biochemical recurrence with a Gleason grade of 8 or greater who completed conventional imaging (Bone Scan and/or CT Scan), Prostacint imaging, and a combined 18F-NaF and 18F-FDG PET/CT. All images were reviewed and compared.
Results PET/CT showed sites of abnormal tracer accumulation that was concerning for malignant/metastatic disease in 11/15 patients. Prostascint imaging showed disease in 6/10 patients, and conventional imaging showed disease in 0/15 patients. When disease was present on both modalities, the lesions were more conspicuous on PET imaging and were identified with more confidence. Discordant positive PET/CT and negative Prostascint scans likely reflect the presence of de-differentiated disease. Only one case was PET negative and prostascint positive, and in that instance, the anatomic correlate was millimetric in size on localization CT.
Conclusions Combined 18F-NaF and 18F-FDG PET/CT could be a viable method of detection of aggressive prostate cancer or at least a useful supplemental diagnostic modality. It also has the potential to provide additional information including classification of disease as well differentiated vs de-differentiated, however additional studies are needed for further evaluation