Conversations With Prostate Cancer Experts

One thought on “Imaging For Bone Metastases

  1. Yes, what Dr. Gomella presented is the most common approach taken by urologists to evaluate bone metastases i.e. a bone scan using Tc99 but it is also out of date by about 14 years with peer-reviewed literature showing the superiority of NaF PET/CT versus Tc99 to detect bone metastases in prostate cancer. The European radiologists have been at least 10 years ahead of us in imaging of PC, be it bone or lymph nodes. Newer PET/CT studies to evaluate bone metastases include 68Ga-PSMA PET/CT as well as Axumin PET-CT. Moreover, MRI has been under-utilized in assessing bone metastases in PC. Again, the European radiologists have led the way with whole body MRI (wb-MRI) which actually is a software application used with existing MRI equipment that American radiologists have ignored. This is really MRI of the axial skeleton (i.e., pelvis, proximal femurs, T & L spine) & not truly whole body. Thus, it is often referred to as MRI of the axial skeleton (MRI-A). Such testing can be done over 20-30 minutes, costs about $400 in Europe, & of course involves no radiation exposure.

    What Dr. Gomella has presented is, or should be, passé. We have advanced technology & we should use it. What is badly needed are head-to-head studies involving the “newer” imaging techniques re specific areas of metastatic concern. Therefore, studies in which patients have NaF PET/CT vs 68Ga-PSMA PET/CT vs Axumin PET-CT vs wb-MRI should be done to assess sensitivity, specificity & accuracy in picking up bone metastases, and similar studies should be done focused on nodal mets, as well as specific focus on recurrence in the prostate gland and/or the prostate bed. There are hundreds of references relating to the above but a few are given below.

    Odewole OA, Tade FI, Nieh PT, et al: Recurrent prostate cancer detection with anti-3-[(18)F]FACBC PET/CT: comparison with CT. Eur J Nucl Med Mol Imaging 43:1773-83, 2016.

    Afshar-Oromieh A, Avtzi E, Giesel FL, et al: The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 42:197-209, 2015.

    Lecouvet FE, Geukens D, Stainier A, et al: Magnetic resonance imaging of the axial skeleton for detecting bone metastases in patients with high-risk prostate cancer: diagnostic and cost-effectiveness and comparison with current detection strategies. J Clin Oncol 25:3281-7, 2007.

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