Skip to main content
SpringerLink
Log in

Treatment Response Assessment of Skeletal Metastases in Prostate Cancer with 18F-NaF PET/CT

  • Original Article
  • Published:
Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To determine the utility of 18F-sodium fluoride positron emission tomography-computed tomography (18F-NaF PET/CT) in the imaging assessment of therapy response in men with osseous-only metastatic prostate cancer.

Methods

In this Institutional Review Board–approved single institution retrospective investigation, we evaluated 21 18F-NaF PET/CT scans performed in 14 patients with osseous metastatic disease from prostate cancer and no evidence of locally recurrent or soft-tissue metastatic disease who received chemohormonal therapy. Imaging-based qualitative and semi-quantitative parameters were defined and compared with changes in serum PSA level.

Results

Qualitative and semi-quantitative image-based assessments demonstrated > 80% concordance with good correlation (SUVmax κ = 0.71, SUVavg κ = 0.62, SUVsum κ = 0.62). Moderate correlation (κ = 0.43) was found between SUVmax and PSA-based treatment response assessments. There was no statistically significant correlation between PSA-based disease progression and semi-quantitative parameters. Qualitative imaging assessment was moderately correlated (κ = 0.52) with PSA in distinguishing responders and non-responders.

Conclusion

18F-NaF PET/CT is complementary to biochemical monitoring in patients with bone-only metastases from prostate cancer which can be helpful in subsequent treatment management decisions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

CT:

computed tomography

PET:

positron emission tomography

PSA:

prostate-specific antigen

MDP:

methylene diphosphonate

NaF:

sodium fluoride

P:

progressor

NP:

non-progressor

R:

responder

NR:

non-responder

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30.

    Article  PubMed  Google Scholar 

  2. O’Sullivan GJ, Carty FL, Cronin CG. Imaging of bone metastasis: an update. World J Radiol. 2015;7:202–11.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Jadvar H, Desai B, Conti PS. Sodium 18F-fluoride PET/CT of bone, joint and other disorders. Semin Nucl Med. 2015;45:58–65.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Langsteger W, Rezaee A, Pirich C, Beheshti M. 18F-NaF-PET/CT and 99mTc-MDP bone scintigraphy in the detection of bone metastases in prostate cancer. Semin Nucl Med. 2016;46:491–501.

    Article  PubMed  Google Scholar 

  5. Iagaru AH, Mittra E, Colletti PM, Jadvar H. Bone-targeted imaging and radionuclide therapy in prostate cancer. J Nucl Med. 2016;57(Suppl 3):19S–24S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Czernin J, Satyamurthy N, Schiepers C. Molecular mechanisms of bone 18F-NaF deposition. J Nucl Med. 2010;51:1826–9.

    Article  CAS  PubMed  Google Scholar 

  7. Bridges RL, Wiley CR, Christian JC, Strohm AP. An introduction to Na(18)F bone scintigraphy:basic principles, advanced imaging concepts, and case examples. J Nucl Med Technol. 2007;35:64–76.

    Article  PubMed  Google Scholar 

  8. Kulshrestha RK, Vinjamuri S, England A, Nightingale J, Hogg P. The role of 18F-sodium fluoride PET/CT bone scans in the diagnosis of metastatic bone disease from breast and prostate Cancer. J Nucl Med Technol. 2016;44:217–22.

    Article  PubMed  Google Scholar 

  9. Even-Sapir E. Imaging of malignant bone involvement by morphologic, scintigraphic, and hybrid modalities. J Nucl Med. 2005;46:1356–67.

    PubMed  Google Scholar 

  10. Even-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I. The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med. 2006;47:287–97.

    PubMed  Google Scholar 

  11. Beheshti M, Rezaee A, Geinitz H, Loidl W, Pirich C, Langsteger W. Evaluation of prostate cancer bone metastases with 18F-NaF and 18F-fluorocholine PET/CT. J Nucl Med. 2016;57(Suppl 3):55S–60S.

    Article  CAS  PubMed  Google Scholar 

  12. Jadvar H. Molecular imaging of prostate cancer: PET radiotracers. AJR Am J Roentgenol. 2012;199:278–91.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Clamp A, danson S, Nguyen H, Cole D, Clemons M. Assessment of therapeutic response in patients with metastatic bone disease. Lancet Oncol. 2004;5:607–16.

    Article  PubMed  Google Scholar 

  14. Woolf DK, Padhani AR, Makris A. Assessing response to treatment of bone metastases from breast cancer: what should be the standard of care? Ann Oncol. 2015;26:1048–57.

    Article  CAS  PubMed  Google Scholar 

  15. Cookson MS, Aus G, Burnett AL, Canby-Hagino ED, D’Amico AV, Dmochowski RR, et al. Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for localized prostate cancer update panel report and recommendations for a standard in the reporting of surgical outcomes. J Urol. 2007;177:540–5.

    Article  CAS  PubMed  Google Scholar 

  16. Roach M 3rd, Hanks G, Thames H Jr, Schellhammer P, Shipley WU, Sokol GH, et al. Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix consensus conference. Int J Radiat Oncol Biol Phys. 2006;65:965–74.

    Article  PubMed  Google Scholar 

  17. Segall G, Delbeke D, Stabin MG, Even-Sapir E, Fair J, Sajdak R, et al. SNM practice guideline for sodium 18F-fluoride PET/CT bone scans 1.0. J Nucl Med. 2010;51:1813–20.

    Article  PubMed  Google Scholar 

  18. Ceci F, Castellucci P, Nanni C, Fanti S. PET/CT imaging for evaluating response to therapy in castration-resistant prostate cancer. Eur J Nucl Med Mol Imaging. 2016;43:2103–4.

    Article  PubMed  Google Scholar 

  19. Simoncic U, Perlman S, Liu G, Staab MJ, Sraus JE, Jeraj R. Comparison of NaF and FDG PET/CT for assessment of treatment response in castration-resistant prostate cancers with osseous metastases. Clin Genitourin Cancer. 2015;13:e7–e17.

    Article  PubMed  Google Scholar 

  20. Jadvar H, Desai B, Ji L, Conti PS, Dorff TB, Groshen SG, et al. Baseline 18F-FDG PET/CT parameters as imaging biomarkers of overall survival in castrate-resistant metastatic prostate cancer. J Nucl Med. 2013;54:1195–201.

    Article  CAS  PubMed  Google Scholar 

  21. Oyama N, Akino H, Suzuki Y, Kanamaru H, Ishida H, Tanase K, et al. FDG PET for evaluating the change of glucose metabolism in prostate cancer after androgen ablation. Nucl Med Commun. 2001;22:963–9.

    Article  CAS  PubMed  Google Scholar 

  22. De Giorgi U, Caroli P, Burgio SL, Menna C, Coteduca V, Bianchi E, et al. Early outcome prediction on 18F-fluorocholine PET/CT in metastatic castration-resistant prostate cancer patients treated with abiraterone. Oncotarget. 2014;5:12448–58.

    Article  PubMed  PubMed Central  Google Scholar 

  23. De Giorgi U, Caroli P, Scarpi E, Conteduca V, Burgio SL, Menna C, et al. 18F-Fluorocholine PET/CT for early response assessment in patients with metastatic castration-resistant prostate cancer treated with enzalutamide. Eur J Nucl Med Mol Imaging. 2015;42:1276–83.

    Article  CAS  PubMed  Google Scholar 

  24. Seitz AK, Rauscher I, Hallr B, Kronke M, Luther S, Heck MM, et al. Preliminary results on response assessment using 68Ga-HBED-CC-PSMA PET/CT in patients with metastatic prostate Cancer undergoing docetaxel chemotherapy. Eur J Nucl Med Mol Imaging. 2018;45:602–12.

    Article  CAS  PubMed  Google Scholar 

  25. Jadvar H, Desai B, Ji L, Conti PS, Dorff TB, Grshen SG, et al. Prospective evaluation of 18F-NaF and 18F-FDG PET/CT in detection of occult metastatic disease in biochemical recurrence of prostate cancer. Clin Nucl Med. 2012;37:637–43.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Shen CT, Qiu ZL, Han TT, Luo QY. Performance of 18F-fluoride PET or PET/CT for the detection of bone metastases: a meta-analysis. Clin Nucl Med. 2015;40:103–10.

    Article  PubMed  Google Scholar 

  27. Jadvar H, Colletti PM. 18F-NaF/223RaCl2 theranostics in metastatic prostate cancer: treatment response assessment and prediction of outcome. Br J Radiol. 2018;91(1091):20170948.

  28. Cook G Jr, Parker C, Chua S, Johnson B, Aksnes AK, Lweington VJ. 18F-fluoride PET: changes in uptake as a method to assess response in bone metastases from castrate-resistant prostate cancer patients treated with 223Ra-chloride (Alpharadin). EJNMMI Res. 2011;1:4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Harmon SA, Perk T, Lin C, Eickhoff J, Choyke PL, Dahut WL, et al. Quantitative assessment of early [18F]sodium fluoride positron emission tomography/computed tomography response to treatment in men with metastatic prostate cancer to bone. J Clin Oncol. 2017;35:2829–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Muzi M, O’Sullivan F, Muzi J, Mankofff D, Yu E. Whole body 18F-fluoride PET SUV imaging to monitor response to dasatinib therapy in castration-resistant prostate cancer bone metastases: secondary results from ACRIN 6687. J Nucl Med. 2018;59(suppl. 1):1465.

    Google Scholar 

  31. Yu EY, Duan F, Muzi M, Deng X, Chin BB, Alumkal JJ, et al. Castration-resistant prostate cancer bone metastasis response measured by 18F-fluoride PET after treatment with dasatinib and correlation with progression-free survival: results from American College of Radiology Imaging Network 6687. J Nucl Med. 2015;56:354–60.

    Article  CAS  PubMed  Google Scholar 

  32. Hillner BE, Siegel BA, Hanna L, Duan F, Quinn B, Shields AF. 18F-fluoride PET used for treatment monitoring of systemic cancer therapy: results from the National Oncologic PET Registry. J Nucl Med. 2015;56:222–8.

    Article  CAS  PubMed  Google Scholar 

  33. Gareen IF, Hillner BE, Hann L, Makineni R, Duan F, Shields AF, et al. Hospice admission and survival after 18F-fluoride PET performed for evaluation of osseous metastatic disease in the National Oncologic PET Registry. J Nucl Med. 2018;59:427–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Wade AA, Scott JA, Kuter I, Fischman AJ. Flare response in 18F-fluoride ion PET bone scanning. AJR Am J Roentgenol. 2006;186:1783–6.

    Article  PubMed  Google Scholar 

  35. Penney KL, Stampfer MJ, Jahn JL, Sinnott JA, Flavin R, Rider JR, et al. Gleason grade progression is uncommon. Cancer Res. 2013;73:5163–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

We acknowledge National Institutes of Health grants R01-CA111613 (PI: H. Jadvar) and P30-CA014089 (USC Norris Comprehensive Cancer Center).

Author information

Authors and Affiliations

  1. Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, 2250 Alcazar St., CSC 102, Los Angeles, CA, 90033, USA

    Erik M. Velez, Bhushan Desai & Hossein Jadvar

Authors
  1. Erik M. Velez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bhushan Desai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hossein Jadvar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hossein Jadvar.

Ethics declarations

Conflict of Interest

Erik M. Velez, Bhushan Desai, and Hossein Jadvar declare no conflicts of interest. There was no direct funding for this study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Velez, E.M., Desai, B. & Jadvar, H. Treatment Response Assessment of Skeletal Metastases in Prostate Cancer with 18F-NaF PET/CT. Nucl Med Mol Imaging 53, 247–252 (2019). https://doi.org/10.1007/s13139-019-00601-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13139-019-00601-1

Keywords

Search

Navigation