Bone scintigraphy as a gatekeeper for the detection of bone metastases in patients with prostate cancer: comparison with
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ORIGINAL ARTICLE
Bone scintigraphy as a gatekeeper for the detection of bone metastases in patients with prostate cancer: comparison with Ga‑68 PSMA PET/CT Meltem Caglar1 · Murat Tuncel1 · Egemen Yildiz1 · Erdem Karabulut2 Received: 27 July 2020 / Accepted: 8 September 2020 © The Japanese Society of Nuclear Medicine 2020
Abstract Objectives Gallium-68-labeled prostate-specific membrane antigen (Ga-PSMA) positron emission tomography (PET)/computed tomography (CT) is a valuable diagnostic tool for the detection of bone metastases in patients with prostate cancer (PCa). However, bone scintigraphy (BS) with technetium-labeled diphosphonates is cheap and widely available for the same patient population. PSMA PET comes with a cost, and financial constraints in the present economic environment may require its more selective use. In this study, we aimed to compare the diagnostic performance of BS with Ga-PSMA PET/CT for the detection of bone metastases in patients with PCa and correlate the results with various clinical and biochemical variables. Materials and methods Ninety-five patients who underwent Ga-PSMA PET/CT and BS within 3 months for newly diagnosed or recurrent PCa were extracted from our database. Lesion, region and patient-based analyses were performed. Clinical and imaging follow-up was used as the reference test. Results were compared with tumor grade, serum prostate-specific antigen (PSA), and alkaline phosphatase (ALP) values. Results On the patient-based analysis, 75% (42/56) and 98.2% (55/56) of the patients with bone metastases were correctly diagnosed by BS and Ga-PSMA PET, respectively. In 26/95 patients with equivocal lesions on BS, Ga-PSMA PET correctly reclassified skeletal involvement in 11 and excluded metastases in 15 patients BS missed bone metastases in 3 patients. The true-positive rate of BS in patients with serum ALP ≥ 120U/L and PSA ≥ 50 ng/ml was 95.8% and 87.5 respectively. Conclusion Ga-PSMA is superior to BS for the evaluation of metastatic disease in patients with PCa. However, BS can also detect bone metastases in patients with PCa with a minimum sensitivity of 75%. Biochemical data are helpful to select patients with a high pretest probability who should undergo BS first as a part of the initial workup from an economic point of view. Due to its higher cost, Ga-PSMA PET should be performed in a selective group of patients when BS results are inconclusive or metastasis-directed therapy is planned. Keywords Prostate cancer · Bone metastases · Bone scan · PSMA · Bone scintigraphy
Introduction The presence of bone metastases indicates a poor prognosis, and the extent of metastatic involvement correlates with increased mortality and morbidity in men with prostate cancer (PCa) [1, 2]. Correct diagnosis is a major challenge for * Murat Tuncel [email protected]; [email protected] 1
Department of Nuclear Medicine, Medical Faculty, Hacettepe University, Sıhhiye, 06100 Ankara, Turkey
Department of Biostatistics, Medical Faculty, Hacettepe University, Ankara, Turke
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