Evaluation of Prostate Cancer Bone Metastases with ¹⁸F-NaF and ¹⁸F-Fluorocholine PET/CT

Abstract

18 F-fluorocholine is a specific promising agent for imaging tumor cell proliferation, particularly in prostate cancer, using PET/CT. It is a beneficial tool in the early detection of marrow-based metastases because it excludes distant metastases and evaluates the response to hormone therapy. In addition, 18 F-fluorocholine has the potential to differentiate between degenerative and malignant osseous abnormalities because degenerative changes are not cholineavid; however, the agent may accumulate in recent traumatic bony lesions. On the other hand, 18 F-NaF PET/CT can indicate increased bone turnover and is generally used in the assessment of primary and secondary osseous malignancies, the evaluation of response to treatment, and the clarification of abnormalities on other imaging modalities or clinical data. 18 F-NaF PET/CT is a highly sensitive method in the evaluation of bone metastases from prostate cancer, but it has problematic specificity, mainly because of tracer accumulation in degenerative and inflammatory bone diseases. In summary, 18 FNaF PET/CT is a highly sensitive method, but 18 F-fluorocholine PET/CT can detect early bone marrow metastases and provide greater specificity in the detection of bone metastases in patients with prostate cancer. However, the difference seems not to be significant.

Apalutamide Treatment and Metastasis-free Survival in Prostate Cancer

“…Newer and more sensitive imaging studies (e.g., prostate-specific membrane antigen positron-emission tomography) have identified metastases in some patients with no evidence of metastases on conventional imaging. [11][12][13] The regulatory approvals of currently marketed treatments for metastatic castration-resistant prostate cancer were based on the results of clinical trials involving men with metastases that were detected on conventional imaging, such as a bone scan or CT. It is possible that more sensitive imaging tests could have identified metastases at baseline in many of the patients in our trial, particularly because of the requirement for a short PSA doubling time at trial entry.…”

The 68Ga/177Lu theragnostic concept in PSMA targeting of castration-resistant prostate cancer: correlation of SUVmax values and absorbed dose estimates

“…18 F-NaF PET is representing skeletal metabolism and its uptake proves not only the presence of vital tumor cells in osteoblastic metastases but also shows an increased bone metabolism in necrotic areas, induced by bisphosphonate therapy, in sclerotic processes as a sign of bone remodeling after successful cancer treatment, including efficient androgen deprivation therapy, and/or fractures as well as in degenerative and inflammatory bone diseases [39,40]. Especially in highly dense sclerotic lesions, 68 Ga-PSMA-HBED-CC PET/CT as well as 18 F-NaF PET/ CT might, therefore, have negative results.…”

Imaging for Metastasis in Prostate Cancer: A Review of the Literature

“…Sodium fluoride (NaF) has high affinity for osteoblasts and reflects the same phenomenon as bone scans. NaF-PET/CT can be used in the evaluation of primary and secondary bone malignancies, highlighting increased bone remodeling and allowing assessment of response in PCa (28). Several studies suggest that NaF-PET is superior to bone scan for the detection of bone metastases if PET is associated with CT (100% sensitivity and 100% specificity vs. 70 and 57%, respectively, for bone scintigraphy alone) (37).…”