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566 68Gallium-HBED-CC-PSMA PET compared to conventional bone scintigraphy for evaluation of bone metastases in prostate cancer patients
566
68Gallium-HBED-CC-PSMA PET compared to conventional bone scintigraphy for evaluation of bone metastases in prostate cancer patients Eur Urol Suppl 2016;15(3);e566
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Eiber M. 1 , Pyka T.1 , Okamoto S. 1 , Rauscher I.1 , Dahlbender M. 2 , Tauber R.2 , Retz M. 2 , Gschwend J. 2 , Schwaiger M. 1 , Maurer T.2 1 Technical
University of Munich, Dept. of Nuclear Medicine, Munich, Germany, 2 Technical University of Munich, Dept. of Urology, Munich,
Germany INTRODUCTION & OBJECTIVES: Bone Metastases (BM) are a common phenomen in advanced Prostate Cancer (PCa). 99m Tc Bone Scintigraphy (BS) currently represents the standard imaging modality for detection and evaluation of BM. Recently, PSMA PET imaging has gained much attention for staging of PCa patients (pts). Thus, the aim of this analysis was to compare the detection efficacy of PSMA PET imaging compared to BS regarding detection efficacy of BM in PCa pts. MATERIAL & METHODS: 29 pts with primary advanced, 27 pts with biochemical recurrent PCa and 37 pts with castrate-resistant metastatic PCa were identified from the institution´s database who had received 68 Gallium-HBED-CC-PSMA PET imaging and BS within 30 days (median 11 days; range 0-29 days). Two experienced nuclear medicine physicians independently reviewed BS and PSMA PET on a patient- and region-basis. In total, nine anatomical regions were evaluated (skull, cervical spine, thoracial spine, lumbar spine and sacrum, shoulders, thorax, pelvis, upper and lower extremities). Lesions were rated according to a 4-point scale: 0: no lesion; 1: metastatic lesion; 2: equivocal lesion; 3: benign lesion) and compared to a Best Valuable Comparator (BVC) based on BS, PET, CT and available clinical and follow-up data and imaging since histology proof was seldom available. Statistical values for BS and PSMA PET regarding detection of BM were determined. RESULTS: 63 (68%) of 93 pts. and 368 (44.4%) of 828 evaluable regions showed BM according to BVC. For both examinations compared to BVC best diagnostic results were obtained, if equivocal lesions were considered as negative for BM. On a patient-basis sensitivity, specificity, accuracy, positive predictive value and negative predictive value for BS were 89.0%, 100%, 92.5%, 100% and 80.6% versus 98.4%, 100%, 98.9%, 100% and 96.8% for PSMA PET. On a region-basis values for BS were 84.9%, 97.4%, 91.8%, 96.3% and 88.8% versus 98.6%, 100%, 99.4%, 100% and 98.9% for PSMA PET. Of note, especially small BM tended to be more visible on PSMA PET compared to BS. CONCLUSIONS: In our analysis, 68 Gallium-HBED-CC-PSMA PET tended to outperform BS for the detection of individual BM as well as determination of overall bone involvement in PCa pts. Therefore, it does not seem necessary to perform additional BS in patients for whom 68 Gallium-HBED-CC-PSMA
PET is available. Furthermore and in contrast to BS, PSMA PET/CT exhibits the advantage to provide
information about PSMA-PET positive local tumor involvement and soft-tissue metastases (lymph nodes, visceral metastases) as well as findings from morphological imaging within one single examination.
68Gallium-HBED-CC-PSMA PET compared to conventional bone scintigraphy for evaluation of bone metastases in prostate cancer patients Eur Urol Suppl 2016;15(3);e566
Print! Print!
Eiber M. 1 , Pyka T.1 , Okamoto S. 1 , Rauscher I.1 , Dahlbender M. 2 , Tauber R.2 , Retz M. 2 , Gschwend J. 2 , Schwaiger M. 1 , Maurer T.2 1 Technical
University of Munich, Dept. of Nuclear Medicine, Munich, Germany, 2 Technical University of Munich, Dept. of Urology, Munich,
Germany INTRODUCTION & OBJECTIVES: Bone Metastases (BM) are a common phenomen in advanced Prostate Cancer (PCa). 99m Tc Bone Scintigraphy (BS) currently represents the standard imaging modality for detection and evaluation of BM. Recently, PSMA PET imaging has gained much attention for staging of PCa patients (pts). Thus, the aim of this analysis was to compare the detection efficacy of PSMA PET imaging compared to BS regarding detection efficacy of BM in PCa pts. MATERIAL & METHODS: 29 pts with primary advanced, 27 pts with biochemical recurrent PCa and 37 pts with castrate-resistant metastatic PCa were identified from the institution´s database who had received 68 Gallium-HBED-CC-PSMA PET imaging and BS within 30 days (median 11 days; range 0-29 days). Two experienced nuclear medicine physicians independently reviewed BS and PSMA PET on a patient- and region-basis. In total, nine anatomical regions were evaluated (skull, cervical spine, thoracial spine, lumbar spine and sacrum, shoulders, thorax, pelvis, upper and lower extremities). Lesions were rated according to a 4-point scale: 0: no lesion; 1: metastatic lesion; 2: equivocal lesion; 3: benign lesion) and compared to a Best Valuable Comparator (BVC) based on BS, PET, CT and available clinical and follow-up data and imaging since histology proof was seldom available. Statistical values for BS and PSMA PET regarding detection of BM were determined. RESULTS: 63 (68%) of 93 pts. and 368 (44.4%) of 828 evaluable regions showed BM according to BVC. For both examinations compared to BVC best diagnostic results were obtained, if equivocal lesions were considered as negative for BM. On a patient-basis sensitivity, specificity, accuracy, positive predictive value and negative predictive value for BS were 89.0%, 100%, 92.5%, 100% and 80.6% versus 98.4%, 100%, 98.9%, 100% and 96.8% for PSMA PET. On a region-basis values for BS were 84.9%, 97.4%, 91.8%, 96.3% and 88.8% versus 98.6%, 100%, 99.4%, 100% and 98.9% for PSMA PET. Of note, especially small BM tended to be more visible on PSMA PET compared to BS. CONCLUSIONS: In our analysis, 68 Gallium-HBED-CC-PSMA PET tended to outperform BS for the detection of individual BM as well as determination of overall bone involvement in PCa pts. Therefore, it does not seem necessary to perform additional BS in patients for whom 68 Gallium-HBED-CC-PSMA
PET is available. Furthermore and in contrast to BS, PSMA PET/CT exhibits the advantage to provide
information about PSMA-PET positive local tumor involvement and soft-tissue metastases (lymph nodes, visceral metastases) as well as findings from morphological imaging within one single examination.