A comparison of prostate cancer bone metastases on18F-sodium fluoride and prostate specific membrane antigen (18F-PSMA) PET/CT: Discordant uptake in the same lesion

Stephanie A. Harmon, Esther Mena, Joanna H. Shih, Stephen Adler, Yolanda McKinney, Ethan Bergvall, Sherif Mehralivand, Adam G. Sowalsky, Anna Couvillon, Ravi A. Madan, James L. Gulley, Janet Eary, Ronnie Mease, Martin Gilbert Pomper, William L. Dahut, Baris Turkbey, Liza Lindenberg, Peter L. Choyke

Research output: Contribution to journalArticlepeer-review


Purpose: Prostate-Specific Membrane Antigen (PSMA) PET/CT has been introduced as a sensitive method for characterizing metastatic prostate cancer. The purpose of this study is to compare the spatial concordance of 18F-NaF PET/CT and 18F-PSMA-targeted PET/CT within prostate cancer bone metastases. Methods: Prostate cancer patients with known bone metastases underwent PSMA-targeted PET/CT 18F-DCFBC or 18F-DCFPyL) and 18F-NaF PET/CT. In pelvic and spinal lesions detected by both radiotracers, regions-of-interest (ROIs) derived by various thresholds of uptake intensity were compared for spatial colocalization. Overlap volume was correlated with uptake characteristics and disease status. Results: The study included 149 lesions in 19 patients. Qualitatively, lesions exhibited a heterogeneous range of spatial concordance between PSMA and NaF uptake from completely matched to completely discordant. Quantitatively, overlap volume decreased as a function of tracer intensity. and disease status, where lesions from patients with castration-sensitive disease showed higher spatial concordance while lesions from patients with castration-resistant disease demonstrated more frequent spatial discordance. Conclusion: As metastatic prostate cancer progresses from castration-sensitive to castration-resistant, greater discordance is observed between NaF PET and PSMA PET uptake. This may indicate a possible phenotypic shift to tumor growth that is more independent of bone remodeling via osteoblastic formation.

Original languageEnglish (US)
Pages (from-to)37676-37688
Number of pages13
Issue number102
StatePublished - Dec 1 2018


  • Bone metastases
  • Prostate cancer
  • Prostate specific membrane antigen
  • Sodium fluoride
  • Spatial analysis

ASJC Scopus subject areas

  • Oncology

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