Comparative Study of 18-F Sodium Fluoride PET/CT and Bone Scan in Determining Bone Lesions in Newly Diagnosed Prostate Cancer Patient

Objective: To compare the diagnostic performance of bone scintigraphy and 18F-NaF-PET/CT in detection of bone metastasis in newly diagnosed high-grade prostate cancer patients. Study Design: Comparative cross-sectional study. Place and Duration of Study: Nuclear Medical Centre, Armed Forces Institute of Pathology and Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Jul 2020 to Dec 2022. Methodology: Newly diagnosed high-grade prostate cancer patients with Gleason score ≥8 who underwent bone scintigraphy followed by 18F-NaF-PET/CT (Sodium Fluoride-Positron Emission Tomography/Computerized Tomography) for staging during study duration were included. We compared the diagnostic accuracy of both imaging modalities in detecting bone metastasis using two-point scale scoring system i.e., metastasis present or not present on per patient basis. Results: A total of 45 patients with mean age 69.66±9.38 years and mean Prostatic Surface Antigen level 36.21±65.07 ng/ml were included. 18F-NaF-PET/CT detected bone metastasis in all 25 patients with bone metastasis (100%) compared to 20(80%) by bone scan. 4 patients had false-positive bone scan while 2 had false-positive 18F-NaF-PET/CT scan. Overall 18F-NaF-PET/CT demonstrated a higher sensitivity, specificity, positive predictive value, negative predictive value and accuracy compared to bone scan (100% vs 80%, 90% vs 80%, 92.59% vs 83.33%, 100% vs 76.19%, 95.56% vs 80% respectively). Conclusion: 18F-NaF-PET/CT has better diagnostic performance than bone scintigraphy for the detection of bone metastasis in newly diagnosed high-grade prostate cancer patients.