A literature review of F-18-fluoride PET/CT and F-18-choline or C-11-choline PET/CT for detection of bone metastases in patients with prostate cancer
ABSTRACT Although the detection of early bone metastases in men with prostate cancer remains a challenge in today's medicine, current guidelines state that bone scintigraphy with Tc-phosphonates (Tc-BS) is the most sensitive method for assessing bone metastases in these patients. In general, it is stated that bone scintigraphy has reasonable sensitivity and low specificity. The aim of this study was to present a review of the contemporary literature on the performance of F-fluoride and C-choline or F-choline and to reconsider the arguments based on which the present European and US guidelines are founded. A literature search was conducted using the Medline database. Data were taken from eligible studies and the level of evidence was scored. Data were pooled to calculate the weighted sensitivity and specificity. Thirteen studies were eligible for inclusion in this review. On a lesion basis, we found a sensitivity and specificity of 84.0 and 97.7% for C-choline and F-choline and 88.6 and 90.7% for F-fluoride, respectively. On a patient basis, the sensitivity and specificity were 85.2 and 96.5% for C-choline and F-choline and 86.9 and 79.9% for F-fluoride, respectively. No significant differences were found between the sensitivity and specificity of C-choline or F-choline and F-fluoride. There was large inconsistency in the reported sensitivity (range 39-100%) and specificity (range 57-80%) for Tc-BS. The literature provides evidence for superior detection of bone metastases by both F-fluoride PET and F-choline or C-choline PET with or without computed tomography (CT) compared with conventional Tc-BS. Guidelines should include F-fluoride PET/CT and C-choline or F-choline PET/CT as alternatives for Tc-BS for the detection of bone metastases in patients with prostate cancer.
SourceAvailable from: Karel Decaestecker[Show abstract] [Hide abstract]
ABSTRACT: Metastases-directed therapy (MDT) with surgery or stereotactic body radiotherapy (SBRT) is emerging as a new treatment option for prostate cancer (PCa) patients with a limited number of metastases (<=3) at recurrence - so called "oligometastases". One of the goals of this approach is to delay the start of palliative androgen deprivation therapy (ADT), with its negative impact on quality of life. However, the lack of a control group, selection bias and the use of adjuvant androgen deprivation therapy prevent strong conclusions from published studies.The aim of this multicenter randomized phase II trial is to assess the impact of MTD on the start of palliative ADT compared to patients undergoing active surveillance.BMC Cancer 09/2014; 14(1):671. DOI:10.1186/1471-2407-14-671 · 3.32 Impact Factor
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ABSTRACT: Purpose of review In the last 10 years, metastatic castration-resistant prostate cancer (mCRPC) treatment has completely changed. Several new agents have been shown to increase mCRPC patients' overall survival. The importance to define castration-resistant prostate cancer as metastatic and to enable earlier detection of cancer progression set a renewed role for prostate cancer (PCa) imaging. Recent findings Recently published data on molecular imaging of metastatic PCa have focused on diagnostic accuracy, clinical impact and prognostic value of newer techniques using PET and MRI. Summary Molecular imaging techniques are more sensitive and accurate than conventional imaging for the early detection of lymph node and bone metastases. New capabilities offered by PET imaging, MRI lymphography and whole-body MRI are consolidating the role of imaging in metastatic PCa management. These techniques are particularly useful for detecting metastasis, a driver for treatment initiation, especially in patients under androgen-deprivation therapy. Moreover, there is an increasing body of evidence supporting the use of metabolic PET and computed tomography as a prognostic biomarker able to predict survival in patients with metastatic PCa.Current Opinion in Supportive and Palliative Care 07/2014; 8(3). DOI:10.1097/SPC.0000000000000076
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ABSTRACT: Background A bone scan is a common method for monitoring bone metastases in patients with advanced prostate cancer. The Bone Scan Index (BSI) measures the tumor burden on the skeleton, expressed as a percentage of the total skeletal mass. Previous studies have shown that BSI is associated with survival of prostate cancer patients. The objective in this study was to investigate to what extent regional BSI measurements, as obtained by an automated method, can improve the survival analysis for advanced prostate cancer. Methods The automated method for analyzing bone scan images computed BSI values for twelve skeletal regions, in a study population consisting of 1013 patients diagnosed with prostate cancer. In the survival analysis we used the standard Cox proportional hazards model and a more advanced non-linear method based on artificial neural networks. The concordance index (C-index) was used to measure the performance of the models. Results A Cox model with age and total BSI obtained a C-index of 70.4%. The best Cox model with regional measurements from Costae, Pelvis, Scapula and the Spine, together with age, got a similar C-index (70.5%). The overall best single skeletal localisation, as measured by the C-index, was Costae. The non-linear model performed equally well as the Cox model, ruling out any significant non-linear interactions among the regional BSI measurements. Conclusion The present study showed that the localisation of bone metastases obtained from the bone scans in prostate cancer patients does not improve the performance of the survival models compared to models using the total BSI. However a ranking procedure indicated that some regions are more important than others.BMC Medical Imaging 07/2014; 14(1):24. DOI:10.1186/1471-2342-14-24 · 0.98 Impact Factor