PURPOSE: To determine the utility of ¹⁸F-sodium fluoride positron emission tomography-computed tomography (¹⁸F-NaF PET/CT) in the imaging assessment of therapy response in men with osseous-only metastatic prostate cancer.METHODS: In this Institutional Review Board-approved single institution retrospective investigation, we evaluated 21 ¹⁸F-NaF PET/CTscans performed in 14 patients with osseous metastatic disease from prostate cancer and no evidence of locally recurrent or soft-tissue metastatic disease who received chemohormonal therapy. Imaging-based qualitative and semi-quantitative parameters were defined and compared with changes in serum PSA level.RESULTS: Qualitative and semi-quantitative image-based assessments demonstrated > 80% concordance with good correlation (SUV(max) κ = 0.71, SUVavg κ = 0.62, SUVsum κ = 0.62). Moderate correlation (κ = 0.43) was found between SUV(max) and PSA-based treatment response assessments. There was no statistically significant correlation between PSA-based disease progression and semi-quantitative parameters. Qualitative imaging assessment was moderately correlated (κ = 0.52) with PSA in distinguishing responders and non-responders.CONCLUSION: ¹⁸F-NaF PET/CT is complementary to biochemical monitoring in patients with bone-only metastases from prostate cancer which can be helpful in subsequent treatment management decisions.
Disease Progression ; Electrons ; Fluorides ; Humans ; Male ; Neoplasm Metastasis ; Positron-Emission Tomography and Computed Tomography ; Prostate ; Prostatic Neoplasms ; Retrospective Studies

PURPOSE: To determine the utility of ¹⁸F-sodium fluoride positron emission tomography-computed tomography (¹⁸F-NaF PET/CT) in the imaging assessment of therapy response in men with osseous-only metastatic prostate cancer. METHODS: In this Institutional Review Board-approved single institution retrospective investigation, we evaluated 21 ¹⁸F-NaF PET/CTscans performed in 14 patients with osseous metastatic disease from prostate cancer and no evidence of locally recurrent or soft-tissue metastatic disease who received chemohormonal therapy. Imaging-based qualitative and semi-quantitative parameters were defined and compared with changes in serum PSA level. RESULTS: Qualitative and semi-quantitative image-based assessments demonstrated > 80% concordance with good correlation (SUV(max) κ = 0.71, SUVavg κ = 0.62, SUVsum κ = 0.62). Moderate correlation (κ = 0.43) was found between SUV(max) and PSA-based treatment response assessments. There was no statistically significant correlation between PSA-based disease progression and semi-quantitative parameters. Qualitative imaging assessment was moderately correlated (κ = 0.52) with PSA in distinguishing responders and non-responders. CONCLUSION ¹⁸F-NaF PET/CT is complementary to biochemical monitoring in patients with bone-only metastases from prostate cancer which can be helpful in subsequent treatment management decisions.

Purpose: The goal of our retrospective single tertiary academic medical center investigation was to examine the added diagnostic value and clinical impact of 68Ga-DOTATATE PET/CT in the therapeutic management of patients with neuroendocrine tumors (NETs). Methods: Imaging database was queried for all “PET-DOTATATE” examinations performed at our tertiary care academic institution using MONTAGE™. The patient’s clinical history and recent prior imaging were reviewed. The additional diagnostic value and clinical management impact of 68Ga-DOTATATE were assessed through retrospective chart review. Results: A total of 81 68Ga-DOTATATE PET/CT scans in 74 patients were found, and 11 patients were excluded from analysis as they had no prior imaging available for comparison, with resultant analysis cohort of 63 patients. Six patients had 2 or more 68GaDOTATATE PET/CT examinations. The most common primary diagnosis was undifferentiated NET (63.5%), followed by carcinoid (27.0%), paraganglioma (4.8%), insulinoma (3.2%), and pheochromocytoma (1.6%). The primary sites of disease from the most to the least common were the pancreas (36.5%), small bowel (22.2%), unknown primary (15.9%), lung (6.3%), large bowel (6.3%), and mesentery (4.8%), and other locations accounted for 7.9%. In patients who had prior imaging available for comparison, there were new lesions identified on 68Ga-DOTATATE PET/CT in 21 patients (33.3%) that were not identified on other prior imaging modalities. Of these patients, 5 underwent subsequent MRI and 1 had a repeat 68Ga-DOTATATE PET/CT to further characterize new lesions seen. Moreover, 15 patients (23.8%) had a change in treatment plan, including altering medical therapy in 9 patients, change in planned extent of surgical management in 5 patients, and cancelation of a planned primary tumor resection in 1 patient with metastatic disease. Conclusion Our retrospective cohort demonstrated that 68Ga-DOTATATE PET/CT improves lesion detection over conventional imaging in 33.3% and impacts the therapeutic management in 23.8% of patients with NET.