Prospective comparison of 68Ga-PSMA PET/CT, 18F-sodium fluoride PET/CT and diffusion weighted-MRI at for the detection of bone metastases in biochemically recurrent prostate cancer

  • Helle D. ZachoEmail author
  • Julie B. Nielsen
  • Ali Afshar-Oromieh
  • Uwe Haberkorn
  • Nandita deSouza
  • Katja De Paepe
  • Katja Dettmann
  • Niels C. Langkilde
  • Christian Haarmark
  • Rune V. Fisker
  • Dennis T. Arp
  • Jesper Carl
  • Jørgen B. Jensen
  • Lars J. Petersen
Original Article



To prospectively compare diagnostic accuracies for detection of bone metastases by 68Ga-PSMA PET/CT, 18F-NaF PET/CT and diffusion-weighted MRI (DW600-MRI) in prostate cancer (PCa) patients with biochemical recurrence (BCR).


Sixty-eight PCa patients with BCR participated in this prospective study. The patients underwent 68Ga-PSMA PET/CT, a 18F-NaF PET/CT and a DW600-MRI (performed in accordance with European Society of Urogenital Radiology guidelines, with b values of 0 and 600 s/mm2). Bone lesions were categorized using a three-point scale (benign, malignant or equivocal for metastases) and a dichotomous scale (benign or metastatic) for each imaging modality by at least two experienced observers. A best valuable comparator was defined for each patient based on study-specific imaging, at least 12 months of clinical follow-up and any imaging prior to the study and during follow-up. Diagnostic performance was assessed using a sensitivity analysis where equivocal lesions were handled as non-metastatic and then as metastatic.


Ten of the 68 patients were diagnosed with bone metastases. On a patient level, sensitivity, specificity and the area under the curve (AUC) by receiver operating characteristic analysis were, respectively, 0.80, 0.98–1.00 and 0.89–0.90 for 68Ga-PSMA PET/CT (n = 68 patients); 0.90, 0.90–0.98 and 0.90–0.94 for 18NaF PET/CT (n = 67 patients); and 0.25–0.38, 0.87–0.92 and 0.59–0.62 for DW600-MRI (n = 60 patients). The diagnostic performance of DW600-MRI was significantly lower than that of 68Ga-PSMA PET/CT and 18NaF PET/CT for diagnosing bone metastases (p < 0.01), and no significant difference in the AUC was seen between 68Ga-PSMA PET/CT and 18NaF PET/CT (p = 0.65).


68Ga-PSMA PET/CT and 18F-NaF PET/CT showed comparable and high diagnostic accuracies for detecting bone metastases in PCa patients with BCR. Both methods performed significantly better than DW600-MRI, which was inadequate for diagnosing bone metastases when conducted in accordance with European Society of Urogenital Radiology guidelines.


PSMA-PET/CT NaF-PET/CT Diffusion-weighted MRI Bone metastases Prostate cancer 



This study was supported by unrestricted grants from the Obel Family Foundation and the Danielsen foundation.

Compliance with ethical standards

Conflict of interest

HDZ received grant funding from the Danielsen Foundation, NdS receives grant funding from Cancer Research UK, KDP is a Cancer Research UK funded fellow and LJP receives grant foundation form the Obel Family Foundation. The authors have no other conflicts of interest regarding the present manuscript.

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.

Supplementary material

259_2018_4058_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 14 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Helle D. Zacho
    • 1
    • 2
    Email author
  • Julie B. Nielsen
    • 1
    • 2
  • Ali Afshar-Oromieh
    • 3
    • 4
  • Uwe Haberkorn
    • 3
    • 5
  • Nandita deSouza
    • 6
  • Katja De Paepe
    • 6
  • Katja Dettmann
    • 7
  • Niels C. Langkilde
    • 8
  • Christian Haarmark
    • 9
  • Rune V. Fisker
    • 1
    • 10
  • Dennis T. Arp
    • 11
  • Jesper Carl
    • 12
  • Jørgen B. Jensen
    • 7
    • 13
  • Lars J. Petersen
    • 1
    • 2
  1. 1.Department of Nuclear Medicine and Clinical Cancer Research CenterAalborg University HospitalAalborgDenmark
  2. 2.Department of Clinical MedicineAalborg UniversityAalborgDenmark
  3. 3.Department of Nuclear MedicineUniversity Hospital HeidelbergHeidelbergGermany
  4. 4.Department of Nuclear MedicineBern University HospitalBernSwitzerland
  5. 5.Clinical Cooperation Unit Nuclear MedicineDKFZHeidelbergGermany
  6. 6.The Institute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUK
  7. 7.Department of UrologyRegional Hospital West JutlandHolstebroDenmark
  8. 8.Department of UrologyAalborg University HospitalAalborgDenmark
  9. 9.Department of Clinical Physiology and Nuclear MedicineHerlev and Gentofte HospitalHerlevDenmark
  10. 10.Department of RadiologyAalborg University HospitalAalborgDenmark
  11. 11.Department of Medical Physics, Oncology DepartmentAalborg University HospitalAalborgDenmark
  12. 12.Department of Oncology, Naestved SygehusZealand University HospitalRoskildeDenmark
  13. 13.Department of Clinical MedicineAarhus UniversityAarhusDenmark

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