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.
"Therefore, we could not compare planar BSI value with SPECT/CT BSI value. A meta-analysis also indicates that PET/CT has higher sensitivity than planar bone scan for detecting of metastases and the former will most likely replace bone scans in the future [23-25]. A problem that remains to be solved is the high cost and limited availability of PET/CT. "
[Show abstract][Hide abstract] 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.
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.
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.
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 · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cancers prone to spread to bone include prostate, lung, kidney, breast and thyroid cancers. While bone scanner has been widely used in the past decades, PET-based imaging modalities are increasingly used. Current modalities of PET imaging of bone metastases include tumor and inflammatory targeting with FDG-PET, bone imaging with NaF-PET, and direct cancer-specific markers such as FDOPA-PET or PET using choline. The cancer-specific metastatic patterns and the relative prognosis conferred by osseous metastases (versus visceral metastases) may determine the need for bone scan, FDG-PET for the detection of bone metastases. Because some cancers have a mixed skeletal and visceral, cocktails PET radiopharmaceuticals may also be discussed in the future. The cancer-specific context and performances of bone scan and PET imaging are discussed.
Bulletin du cancer 10/2013; 100(11). DOI:10.1684/bdc.2013.1847 · 0.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There is an expanding and exciting repertoire of PET imaging radiotracers for urogenital diseases, particularly in prostate cancer, renal cell cancer, and renal function. Prostate cancer is the most commonly diagnosed cancer in men. With growing therapeutic options for the treatment of metastatic and advanced prostate cancer, improved functional imaging of prostate cancer beyond the limitations of conventional CT and bone scan is becoming increasingly important for both clinical management and drug development. PET radiotracers, apart from (18)F-FDG, for prostate cancer are (18)F-sodium fluoride, (11)C-choline, and (18)F-fluorocholine, and (11)C-acetate. Other emerging and promising PET radiotracers include a synthetic l-leucine amino acid analogue (anti-(18)F-fluorocyclobutane-1-carboxylic acid), dihydrotestosterone analogue ((18)F-fluoro-5α-dihydrotestosterone), and prostate-specific membrane antigen-based PET radiotracers (eg, N-[N-[(S)-1,3-dicarboxypropyl]carbamoyl]-4-(18)F-fluorobenzyl-l-cysteine, (89)Zr-DFO-J591, and (68)Ga [HBED-CC]). Larger prospective and comparison trials of these PET radiotracers are needed to establish the role of PET/CT in prostate cancer. Although renal cell cancer imaging with FDG-PET/CT is available, it can be limited, especially for detection of the primary tumor. Improved renal cell cancer detection with carbonic anhydrase IX (CAIX)-based antibody ((124)I-girentuximab) and radioimmunotherapy targeting with (177)Lu-cG250 appear promising. Evaluation of renal injury by imaging renal perfusion and function with novel PET radiotracers include p-(18)F-fluorohippurate, hippurate m-cyano-p-(18)F-fluorohippurate, and rubidium-82 chloride (typically used for myocardial perfusion imaging). Renal receptor imaging of the renal renin-angiotensin system with a variety of selective PET radioligands is also becoming available for clinical translation.
Seminars in nuclear medicine 03/2014; 44(2):93-109. DOI:10.1053/j.semnuclmed.2013.10.008 · 3.34 Impact Factor
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