Prospective study evaluating Na18F PET/CT in predicting clinical outcomes and survival in advanced prostate cancer

Andrea B. Apolo, Liza Lindenberg, Joanna H. Shih, Esther Mena, Joseph W. Kim, Jong C. Park, Anna Alikhani, Yolanda Y. McKinney, Juanita Weaver, Baris Turkbey, Howard L. Parnes, Lauren V. Wood, Ravi A. Madan, James L. Gulley, William L. Dahut, Karen A. Kurdziel, Peter L. Choyke

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


This prospective pilot study evaluated the ability of Na18F PET/CT to detect and monitor bone metastases over time and its correlation with clinical outcomes and survival in advanced prostate cancer. Methods: Sixty prostate cancer patients, including 30 with and 30 without known bone metastases by conventional imaging, underwent Na18F PET/CT at baseline, 6 mo, and 12 mo. Positive lesions were verified on follow-up scans. Changes in SUVs and lesion number were correlated with prostate-specific antigen change, clinical impression, and overall survival. Results: Significant associations included the following: SUV and prostate-specific antigen percentage change at 6 mo (P = 0.014) and 12 mo (P = 0.0005); SUV maximal percentage change from baseline and clinical impression at 6 mo (P = 0.0147) and 6-12 mo (P5 0.0053); SUV change at 6mo and overall survival (P = 0.018); number of lesions on Na18F PET/CT and clinical impression at baseline (P < 0.0001), 6 mo (P = 0.0078), and 12 mo (P = 0.0029); and number of lesions on Na18F PET/CT per patient at baseline and overall survival (P = 0.017). In an exploratory analysis, paired 99mTc-methylene diphosphonate bone scans (99mTc-BS) were available for 35 patients at baseline, 19 at 6 mo, and 14 at 12 mo (68 scans). Malignant lesions on Na18F PET/CT (n 5 57) were classified on 99mTc-BS as malignant 65% of the time, indeterminate 25% of the time, and negative 10% of the time. Additionally, 69% of paired scans showed more lesions on Na18F PET/CT than on 99mTc-BS. Conclusion: The baseline number of malignant lesions and changes in SUV on follow-up Na18F PET/CT significantly correlate with clinical impression and overall survival. Na18F PET/CT detects more bone metastases earlier than 99mTc-BS and enhances detection of new bone disease in high-risk patients.

Original languageEnglish (US)
Pages (from-to)886-892
Number of pages7
JournalJournal of Nuclear Medicine
Issue number6
StatePublished - Jun 1 2016
Externally publishedYes


  • Bone metastases
  • NaF PET/CT
  • Nuclear imaging in prostate cancer
  • Prostate cancer
  • Sodium fluoride

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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