18F-NaF PET/CT imaging versus 99mTc-MDP scintigraphy in assessing metastatic bone disease in patients with prostate cancer

Abstract

Prostate Cancer (ProCa) is one of the most commonly encountered malignancies in men, with variable incidence and prevalence rates across different parts of the world. Despite being a slow-growing tumor, ProCa can be fatal when giving distant metastases, with the skeleton being the most common metastatic sites. Osseous metastases in ProCa patients can be osteoblastic, osteolytic or mixed, and are associated with significant morbidity. Thus, early detection and precise assessment of skeletal involvement is critical for prognosis and accurate management of ProCa patients. Conventional bone scintigraphy (BS) using 99m-Technetium ( 99m Tc) labeled radiopharmaceuticals with planar imaging, SPECT imaging and hybrid SPECT/CT imaging, has been employed for decades in the assessment of metastatic bone disease of ProCa patients, due to its low cost and availability. However, skeletal imaging with modern hybrid PET/CT systems using 18 Fluorine-Sodium fluoride ( 18 F-NaF), exhibits superior diagnostic performance compared to conventional BS in addressing the task of evaluating bony involvement in ProCa patients. The superior spatial resolution of PET over SPECT, the preferable pharmacokinetics of 18 F-NaF over 99m Tc labeled agents, and the superior inherent quantitative capabilities of PET-imaging, result in the superior diagnostic performance of 18 F-NaF PET/CT imaging, which is documented in the current review article. Given the widespread availability of PET/CT scanners, and the decreasing cost of 18 F-NaF production, it is recommended that conventional BS should be replaced by the superior 18 F-NaF PET/CT imaging in the work-up of ProCa patients.