18-Fluoride labeled sodium fluoride positron emission tomography with computer tomography: the impact of pretreatment staging in intermediate- and high-risk prostate cancer

Simon Jd Harley; Richard Hoffmann; Dylan Bartholomeusz; Peter Sutherland; Barry Chatterton; Michael Kitchener; Prab Takhar; Chris Tsopelas; Andrew Fuller; Richard Wells; Raj Singh-Rai; John Bolt

doi:10.1016/j.prnil.2017.12.002

18-Fluoride labeled sodium fluoride positron emission tomography with computer tomography: the impact of pretreatment staging in intermediate- and high-risk prostate cancer

Prostate Int. 2018 Jun;6(2):50-54. doi: 10.1016/j.prnil.2017.12.002. Epub 2017 Dec 27.

Authors

Affiliations

¹ Department of Urology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
² Department of Urology, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
³ Department of Surgery, University of Adelaide, South Australia, Australia.
⁴ Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
⁵ Dr Jones and Partners, Tennyson Centre, Adelaide, South Australia, Australia.
⁶ South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.

Abstract

Background: 18-Fluoride labeled sodium fluoride (Na-18-F) positron emission tomography with computer tomography (PET/CT) has a better sensitivity and specificity than whole body bone scan (WBBS) in detecting osseous metastatic prostate cancer. We performed a pilot study of 20 men to examine what level of impact Na-18-F PET/CT has on management plans when used for staging newly diagnosed prostate cancer.

Materials and methods: Twenty men were prospectively enrolled into the study in South Australia. Men were eligible if they had newly diagnosed, untreated, and biopsy-confirmed intermediate- or high-risk prostate cancer (D'Amico classification). WBBS and Na-18-F PET/CT scans were performed within 1 week of each other. Following review of the WBBS, treatment type and intent was documented by the treating urologist. The Na-18-F PET/CT scan was then reviewed. The impact of the Na-18-F PET/CT was measured on whether treatment modality or intent was subsequently altered: high impact = treatment intent or modality was changed; medium impact = treatment modality was modified; low impact = no change in treatment.

Results: In 18 men (90%), the WBBS and Na-18-F PET/CT were negative for osseous metastases. In one man (5%), the WBBS demonstrated widespread osseous metastases which were similarly demonstrated on the Na-18-F PET/CT. One man (5%) had a normal WBBS; however, the Na-18-F PET/CT demonstrated widespread osseous metastases. Subsequently, in 19 men (95%), the results of the two scans were congruent and the addition of the Na-18-F PET/CT scan demonstrated a low impact on management. In one man (5%), the addition of the Na-18-F PET/CT had a high impact as treatment type and intent was altered.

Conclusions: Our pilot study is the first of its kind in Australia, and our findings suggest that Na-18-F PET/CT is a safe and feasible modality for staging prostate cancer. However, its true impact on prostate cancer management warrants further investigation.

Keywords: Metastases; Positron emission tomography with computer tomography; Prostate cancer; Sodium fluoride; Whole body bone scan.