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Zacho HD, Petersen LJ. Bone Flare to Androgen Deprivation Therapy in Metastatic, Hormone-Sensitive Prostate Cancer on 68Ga-Prostate-Specific Membrane Antigen PET/CT. Clin Nucl Med 2018; 43:e404-e406. [PMID: 30222680 DOI: 10.1097/rlu.0000000000002273] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 69-year-old man with newly diagnosed prostate cancer PSA 274 ng/mL, Gleason 4+3, T-stage 3b) underwent Ga-PSMA PET/CT for staging with follow-up scans 6 and 13 weeks after androgen deprivation therapy (ADT) initiation. Six weeks after ADT initiation, lymph node metastases observed at staging showed metabolic and radiological regression, whereas the skeleton showed increased PSMA uptake in existing bone metastases and several new PSMA-avid lesions. Skeletal PSMA uptake decreased after 13 weeks of ADT, and prostate-specific antigen decreased to 16 ng/mL. These findings suggest the presence of the flare phenomenon to ADT in bone metastases seen on PSMA PET/CT.
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Affiliation(s)
- Helle D Zacho
- From the Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital; and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Fonager RF, Zacho HD, Langkilde NC, Fledelius J, Ejlersen JA, Hendel HW, Haarmark C, Moe M, Mortensen JC, Jochumsen MR, Petersen LJ. Prospective comparative study of 18F-sodium fluoride PET/CT and planar bone scintigraphy for treatment response assessment of bone metastases in patients with prostate cancer. Acta Oncol 2018; 57:1063-1069. [PMID: 29447047 DOI: 10.1080/0284186x.2018.1438651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM To compare 18F-sodium fluoride positron emission tomography/computed tomography (NaF PET/CT) and 99mTc-labelled diphosphonate bone scan (BS) for the monitoring of bone metastases in patients with prostate cancer undergoing anti-cancer treatment. MATERIAL AND METHODS Data from 64 patients with prostate cancer were included. The patients received androgen-deprivation therapy (ADT), next-generation hormonal therapy (NGH) or chemotherapy. The patients had a baseline scan and 1-3 subsequent scans during six months of treatment. Images were evaluated by experienced nuclear medicine physicians and classified for progressive disease (PD) or non-PD according to the Prostate Cancer Working Group 2 (PCWG-2) criteria. The patients were also classified as having PD/non-PD according to the clinical and prostate-specific antigen (PSA) responses. RESULTS There was no difference between NaF PET/CT and BS in the detection of PD and non-PD during treatment (McNemar's test, p = .18). The agreement between BS and NaF PET/CT for PD/non-PD was moderate (Cohen's kappa 0.53, 95% confidence interval 0.26-0.79). Crude agreement between BS and NaF PET/CT for the assessment of PD/non-PD was 86% (89% for ADT, n = 28; 88% for NGH, n = 16, and 80% for chemotherapy, n = 20). In most discordant cases, BS found PD when NaF PET/CT did not, or BS detected PD on an earlier scan than NaF PET/CT. Biochemical progression (27%) occurred more frequently than progression on functional imaging (BS, 22% and NaF PET/CT, 14%). Clinical progression was rare (11%), and almost exclusively seen in patients receiving chemotherapy. CONCLUSION There was no difference between NaF PET/CT and BS in the detection of PD and non-PD; however, BS seemingly detects PD by the PCWG-2 criteria earlier than NaF-PET, which might be explained by the fact that NaF-PET is more sensitive at the baseline scan.
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Affiliation(s)
- Randi Fuglsang Fonager
- Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helle Damgaard Zacho
- Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Joan Fledelius
- Department of Nuclear Medicine, Regional Hospital West Jutland, Herning, Denmark
| | - June Anita Ejlersen
- Department of Nuclear Medicine, Regional Hospital West Jutland, Herning, Denmark
| | | | - Christian Haarmark
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Herlev, Denmark
| | - Mette Moe
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Mads Ryø Jochumsen
- Department of Urology, Regional Hospital West Jutland, Holstebro, Denmark
| | - Lars Jelstrup Petersen
- Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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