Diagnostic performance of bone scintigraphy and 11C-Choline PET/CT in the detection of bone metastases in patients with biochemical recurrence of prostate cancer

Aim: To compare bone scan (BS) with C-11-Choline PET/CT for the detection of bone metastases in patients with biochemical recurrence of prostate cancer (PC). Material and Methods: A total of 169 patients with biochemical recurrence of PC(PSA:2.4-58 ng/ml) who were referred for both exams (0-15 days-in-between) were included. Lesion-detection-rate per patients and lesions were analyzed for both BS and C-11-Choline PET/CT. Metastasis diagnosis was reached by: biopsy, CT/F-18-Fluoride PET/MRI confirmation, or evidence of progression in subsequent imaging procedures. Results: A total of 91 lesions were found to be active in BS and/or C-11-choline PET/CT (40 patients), with 78 of which were metastatic. BS detected 38 blastic, 2 lytic and 10 non-CT-evident lesions. C-11-Choline PET/CT detected 41 blastic, 4 lytic and 29 non-CT-evident lesions. BS and C-11-Choline PET/CT sensitivities were 65.4% and 96.1%; specificities ere 38.5 and 92.3% (chi(2) 8.27, p < 0.04). Both imaging techniques were negative in 118 patients. Tracer avid lesions were found in 51 patients: with 30/51 being BS and C-11-Choline PET/CT concordant; in 21/51 patients had discordant lesions (kappa 0.712, p = 0.00). Lesions were absolutely discordant in 10/19 patients,: 5 FN BS, 2 FP BS (degenerative changes: dysplasia), 1 FN C-11-Choline PET/CT (blastic), 1 FP C-11-Choline PET/CT (degenerative), 1 out of field-of-view lesion with C-11-Choline PET/CT (tibia alone). C-11-Choline PET/CT showed extraosseous involvement in 26/51 patients with bone metastases: 9 local recurrences, 5 infra-diaphragmatic-lymph-nodes, 2 supra-diaphragmatic, 5 local and infra-diaphragmatic, 4 infra- and supra-diaphragmatic, 1 supra-diaphragmatic and lung metastases. Conclusion: C-11-Choline PET/CT yielded better sensitivity and specificity than BS for the detection of bone involvement in patients with biochemical recurrence of PC and allowed extraosseous restaging, with an impact in the clinical management of these patients. (C) 2014 Elsevier Espana, S.L.U. and SEMNIM. All rights reserved.