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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

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Abstract

Purpose

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).

Methods

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.

Results

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).

Conclusion

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.

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Funding

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

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, Postboks 365, DK-9100, Aalborg, Denmark

    Helle D. Zacho, Julie B. Nielsen, Rune V. Fisker & Lars J. Petersen

  2. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Helle D. Zacho, Julie B. Nielsen & Lars J. Petersen

  3. Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany

    Ali Afshar-Oromieh & Uwe Haberkorn

  4. Department of Nuclear Medicine, Bern University Hospital, Bern, Switzerland

    Ali Afshar-Oromieh

  5. Clinical Cooperation Unit Nuclear Medicine, DKFZ, Heidelberg, Germany

    Uwe Haberkorn

  6. The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK

    Nandita deSouza & Katja De Paepe

  7. Department of Urology, Regional Hospital West Jutland, Holstebro, Denmark

    Katja Dettmann & Jørgen B. Jensen

  8. Department of Urology, Aalborg University Hospital, Aalborg, Denmark

    Niels C. Langkilde

  9. Department of Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, Herlev, Denmark

    Christian Haarmark

  10. Department of Radiology, Aalborg University Hospital, Aalborg, Denmark

    Rune V. Fisker

  11. Department of Medical Physics, Oncology Department, Aalborg University Hospital, Aalborg, Denmark

    Dennis T. Arp

  12. Department of Oncology, Naestved Sygehus, Zealand University Hospital, Roskilde, Denmark

    Jesper Carl

  13. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Jørgen B. Jensen

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  1. Helle D. Zacho
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Correspondence to Helle D. Zacho.

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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.

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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.

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Zacho, H.D., Nielsen, J.B., Afshar-Oromieh, A. et al. 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. Eur J Nucl Med Mol Imaging 45, 1884–1897 (2018). https://doi.org/10.1007/s00259-018-4058-4

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