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Comparison of bone scintigraphy and 68Ga-PSMA PET for skeletal staging in prostate cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of our study was to compare the diagnostic performance of 68Ga-PSMA PET and 99mTc bone scintigraphy (BS) for the detection of bone metastases in prostate cancer (PC) patients.

Methods

One hundred twenty-six patients who received planar BS and PSMA PET within three months and without change of therapy were extracted from our database. Bone lesions were categorized into benign, metastatic, or equivocal by two experienced observers. A best valuable comparator (BVC) was defined based on BS, PET, additional imaging, and follow-up data. The cohort was further divided into clinical subgroups (primary staging, biochemical recurrence, and metastatic castration-resistant prostate cancer [mCRPC]). Additionally, subgroups of patients with less than 30 days delay between the two imaging procedures and with additional single-photon emission computed tomography (SPECT) were analyzed.

Results

A total of 75 of 126 patients were diagnosed with bone metastases. Sensitivities and specificities regarding overall bone involvement were 98.7–100 % and 88.2–100 % for PET, and 86.7–89.3 % and 60.8–96.1 % (p < 0.001) for BS, with ranges representing results for ‘optimistic’ or ‘pessimistic’ classification of equivocal lesions. Out of 1115 examined bone regions, 410 showed metastases. Region-based analysis revealed a sensitivity and specificity of 98.8–99.0 % and 98.9–100 % for PET, and 82.4–86.6 % and 91.6–97.9 % (p < 0.001) for BS, respectively. PSMA PET also performed better in all subgroups, except patient-based analysis in mCRPC.

Conclusion

Ga-PSMA PET outperforms planar BS for the detection of affected bone regions as well as determination of overall bone involvement in PC patients. Our results indicate that BS in patients who have received PSMA PET for staging only rarely offers additional information; however, prospective studies, including a standardized integrated x-ray computed tomography (SPECT/CT) protocol, should be performed in order to confirm the presented results.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, Munich, Germany

    Thomas Pyka, Shozo Okamoto, Markus Schwaiger & Matthias Eiber

  2. Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Shozo Okamoto & Nagara Tamaki

  3. Department of Urology, Klinikum rechts der Isar der TU München, Munich, Germany

    Marielena Dahlbender, Robert Tauber, Margitta Retz, Matthias Heck & Tobias Maurer

Authors
  1. Thomas Pyka
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  2. Shozo Okamoto
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  3. Marielena Dahlbender
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  5. Margitta Retz
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  7. Nagara Tamaki
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  9. Tobias Maurer
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  10. Matthias Eiber
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Corresponding author

Correspondence to Thomas Pyka.

Ethics declarations

This study was supported by funding from the Faculty of Medicine of the Technical University of Munich (grant to TP: KKF B11-14). MS has received funding from the European Union Seventh Framework Program (FP7) under Grant Agreement No. 294582 ERC Grant MUMI. The development of 68Ga-PSMA synthesis was supported by SFB 824 (Project Z1) from the Deutsche Forschungsgemeinschaft, Bonn, Germany. The research leading to these results has received funding from the European Union Seventh Framework Program (FP7) under Grant Agreement No. 256984 EndoTOFPET. The authors declare they have no conflicts of interest.

All procedures performed 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 was obtained from all individual participants included in the study as part of the clinical routine. The retrospective analysis was approved by the institutional review board of the Technical University of Munich (permit 5665/13).

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Tobias Maurer and Matthias Eiber share joint senior authorship

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Pyka, T., Okamoto, S., Dahlbender, M. et al. Comparison of bone scintigraphy and 68Ga-PSMA PET for skeletal staging in prostate cancer. Eur J Nucl Med Mol Imaging 43, 2114–2121 (2016). https://doi.org/10.1007/s00259-016-3435-0

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  • DOI: https://doi.org/10.1007/s00259-016-3435-0

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