NaF-PET Imaging Helps Evaluate Prostate Cancer Treatment

Using PET imaging with sodium fluoride (NaF) allowed clinicians to evaluate treatment progress and progression of osseous metastases among patients with prostate cancer, changing treatment if appropriate, according to a study published in the Journal of Nuclear Medicine.

Researchers from the Massey Cancer Center at Virginia Commonwealth University in Richmond sought to determine if the PET imaging was an effective measurement of prostate cancer treatment compared with bone scintigraphy. The National Oncologic PET Registry (NOPR) developed a NaF-PET registry built on the foundation of its prior registry for PET with 18F-FDG. Men with prostate cancer represented 72 percent of the cases.

Prospective data were collected before and after testing with NaF-PET among men aged 65 or older: 1,024 men for initial staging (IS), 1,997 with suspected first osseous metastasis (FOM) and 510 who had suspected progression of osseous metastasis (POM).

In reviewing the findings, the researchers noted the referring physicians said they would have used other advanced imaging, such as CT, MRI or 18F-FDG to assess the patients had NaF-PET not been available in about half the cases.

The treatment plans were changed for more than half of all patients after the NaF-PET imaging:

Patient group

Change in treatment plan

IS

77 percent

FOM

52 percent

POM

71 percent

When intended management was classified as either treatment or nontreatment, the overall change in intended management ranged from 44 percent to 52 percent and from 12 percent to 16 percent if no effect was assumed for those cases with pre-PET plans for other imaging (imaging-adjusted impact).

Interpreting physicians findings:

Patient group

Definite findings of bone metastasis

IS

14 percent

FOM

29 percent

POM

76 percent

The NaF-PET had a “high overall impact, principally related to its effect on replacing intended use of other advanced imaging,” the authors concluded. “Its imaging-adjusted impact was similar to that observed with 18F-FDG PET for restaging or suspected recurrence in other cancer types.”