Research ArticleOncology

No Added Value of 18F-Sodium Fluoride PET/CT for the Detection of Bone Metastases in Patients with Newly Diagnosed Prostate Cancer with Normal Bone Scintigraphy

Helle D. Zacho, Mads R. Jochumsen, Niels C. Langkilde, Jesper C. Mortensen, Christian Haarmark, Helle W. Hendel, Jørgen B. Jensen and Lars J. Petersen
Journal of Nuclear Medicine December 2019, 60 (12) 1713-1716; DOI: https://doi.org/10.2967/jnumed.119.229062

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Outline of the study. Patients with negative standard imaging* who were undergoing radical prostatectomy were offered inclusion in the study. NaF PET/CT was performed between inclusion in the study and up to 1 mo after radical prostatectomy within the time span marked in gray. The results of the NaF PET/CT scan were unblinded 6 mo after radical prostatectomy. *Standard imaging consists of bone scintigraphy with/without SPECT/CT and diagnostic CT. RP = radical prostatectomy

Tables

  • TABLE 1

    Patient Demographics and Clinical Characteristics

    Patients, n81
    Age (y), mean (range)65 (47–77)
    PSA (ng/mL), mean (range)10.2 (2.3–27)
    Bone scan before inclusion
     Planar whole body49
     Planar whole body + SPECT/CT32
    Gleason
     < 7, n5
     7 (3 + 4), n46
     7 (4 + 3), n18
     > 7, n12
    T-stage
     T1, n41
     T2, n39
     T3, n1
    EAU risk score
     Intermediate risk, n60
     High risk, n21
    PSA response 6 mo after RP
     Biochemical response*, n75
     Biochemical failure†, n6

    • ↵* PSA < 0.2 ng/mL at 6 wk and at 6 mo after radical prostatectomy.

    • ↵† PSA ≥ 0.2 ng/mL at 6 wk or at 6 mo after radical prostatectomy.

    • EAU = European Association of Urology; PSA = prostate-specific antigen; RP = radical prostatectomy.

  • TABLE 2

    Diagnosis According to NaF PET/CT at Staging Compared with Outcome After Radical Prostatectomy

    Postoperative classification
    Biochemical response* n = 75Biochemical failure† n = 6
    NaF PET/CTBone metastases, n = 110
    Equivocal, n = 770
    No bone metastases, n = 73676

    • ↵* PSA < 0.2 ng/mL 6 wk and 6 mo after radical prostatectomy.

    • ↵† PSA ≥ 0.2 ng/mL at 6 wk or at 6 mo after radical prostatectomy.

  • TABLE 3

    Patients with PSA ≥ 0.1 ng/mL 6 Wk or 6 Mo After Radical Prostatectomy

    PatientBone metastases according to NaF PET/CT*PSA value at 6 wk and 6 mo after radical prostatectomyAdditional imaging during 24 mo of follow-upClinical follow-up and PSA levels after radical prostatectomy – 24 mo of follow-up
    1No bone metastases0.2 ng/mL at 6 wk, 0.1 ng/mL at 6 moPSMA PET/CT and NaF PET/CT 6 mo after radical prostatectomy revealed no bone metastasesPSA levels continuously 0.1 ng/mL at 24 mo after radical prostatectomy
    2No bone metastases0.1 ng/mL at 6 wk,ceCT at 12 mo after radical  prostatectomy revealed no bone  metastasesPSA levels 0.9 ng/mL at 24 mo after  radical prostatectomy. Have started ADT.  No skeletal related symptoms
    0.2 ng/mL at 6 mo
    3No bone metastases1.2 ng/mL at 6 wkPSMA PET/CT at 6 mo after radical  prostatectomy revealed no bone  metastasesHave started ADT. No skeletal  related symptoms
    1.4 ng/mL at 6 mo
    4No bone metastases0.6 ng/mL at 6 wkPSMA PET/CT at 6 mo after  radical prostatectomy and ceCT  18 mo after radical prostatectomy  revealed no bone metastasesHave started ADT. No skeletal  related symptoms
    0.8 ng/mL at 6 mo
    5No bone metastases0.1 ng/mL at 6 wk,PSMA PET/CT at 6 and 15 mo after  radical prostatectomy and ceCT  18 mo after radical prostatectomy  revealed no bone metastasesPositive surgical margins. No skeletal  related symptoms
    0.2 ng/mL at 6 mo
    6No bone metastases0.3 ng/mL at 6 wkPSMA PET/CT 2 mo after radical  prostatectomy revealed no bone  metastasesSalvage radiotherapy of the  prostatic bed 4 mo postsurgery without  concomitant systematic therapy,  thereafter PSA < 0.1 ng/mL

    • ↵* Consensus diagnosis of 2 blinded observers (3-point scale).

    • ceCT = contrast-enhanced CT; PSMA = prostate-specific membrane antigen; ADT = androgen deprivation therapy.

Additional Files

Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Bookmark this article

Jump to section

Keywords