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Purpose  To investigate the added value and diagnostic accuracy of  68 Ga-PSMA PET/CT versus bone scintigraphy (BS) for bone metastasis detection at the primary staging of prostate cancer (PCa).    Methods  Inclusion criteria involved consecutive patients with newly diagnosed intermediate- to high-risk PCa, who had undergone BS, mostly with supplementary SPECT/low-dose CT, and  68 Ga-PSMA-11 PET/CT within less than 3 months without therapy initiation between the two investigations. BS was evaluated according to clinical routine and reported as no bone metastases (M0), bone metastases (M1), or equivocal (Me). The  68 Ga-PSMA-11 PET/CT was blindly evaluated by three specialists as M0, M1, or Me at the patient level. Sensitivity analyses were conducted using a “best valuable comparator” using all available imaging and clinical follow-up as a reference.    Results  In total, 112 patients were included;  68 Ga-PSMA-11 PET/CT showed a sensitivity of 1.00, specificity of 0.93–0.96, positive predictive value of 0.74–0.81, and negative predictive value of 1.00.  68 Ga-PSMA-11 PET/CT revealed bone metastases in 8 of 81 patients with M0 disease according to BS.  68 Ga-PSMA-11 PET/CT confirmed the presence of bone metastases in all patients ( n  = 9) with M1 disease according to BS. In patients with Me by BS,  68 Ga-PSMA PET/CT provided a definite result in 20 of 22 patients.  68 Ga-PSMA-11 PET/CT resulted in a false-positive answer in four patients with solitary rib lesions.    Conclusion   68 Ga-PSMA-11 PET/CT revealed bone metastases in 10% of patients without bone metastases on BS and in 36% patients with indeterminate BS. However, solitary PSMA-avid lesions in the ribs should be interpreted cautiously as they may represent false-positive findings.

ejnmmi research

Added value of 68Ga-PSMA PET/CT for the detection of bone metastases in patients with newly diagnosed prostate cancer and a previous 99mTc bone scintigraphy