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Peer-reviewedCC BY 4.0European Journal of Nuclear Medicine and Molecular Imaging

Risk of bone metastases on [18F]NaF PET/CT in 734 patients with newly diagnosed prostate cancer

  • Claus Madsen1
  • Helle D. Zacho2,3
  • Rasmus Bisbjerg4
  • Dan Fuglø1
  • Peter B. Østergren4,5
5 affiliations
  1. 1Department of Nuclear Medicine, Copenhagen University Hospital Herlev and Gentofte, Borgmester Ib Juuls Vej 31, 2730 Herlev, Denmark
  2. 2Department of Nuclear Medicine and Clinical Cancer Research Centre, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
  3. 3Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  4. 4Department of Urology, Copenhagen University Hospital Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
  5. 5Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Abstract

Purpose: International guidelines recommend assessment for bone metastases in patients with high-risk prostate cancer (PC) and those with unfavourable intermediate-risk disease. These recommendations are largely based on studies using planar bone scintigraphy. We aimed to assess the diagnostic accuracy of [18F]sodium fluoride ([18F]NaF) PET/CT in newly diagnosed PC. We also evaluated the clinical utility of routine bone imaging in patients with unfavourable intermediate-risk disease and International Society of Urological Pathology grade group (ISUP GG) 3.

Methods: This retrospective single-center study included 734 consecutive patients with newly diagnosed PC who underwent [18F]NaF PET/CT for primary staging. Patients were classified according to the current European Association of Urology risk classification, with the intermediate-risk subgroup restricted to patients with ISUP GG 3. All scan reports were retrospectively reviewed, and patient-level findings regarding bone metastases were validated against a reference standard based on follow-up imaging and clinical data. Sensitivity, specificity, and predictive values were calculated.

Results: Of the 734 patients, 607 (83%) had high-risk disease and 127 (17%) had intermediate-risk disease with ISUP GG 3. Overall, bone metastases were detected in 225 patients (31%). Among high-risk patients, 224 (37%) had bone metastases, whereas only 1 of 127 intermediate-risk patients (0.8%) had bone metastases on [18F]NaF PET/CT. Follow-up identified one additional potential false-negative case in the intermediate-risk group. Among patients with a conclusive reference standard (n = 689), sensitivity and specificity were 0.90 and 0.99, respectively.

Conclusion: [18F]NaF PET/CT demonstrates high diagnostic accuracy for the detection of bone metastases in newly diagnosed PC. However, given the very low prevalence of bone metastases, its clinical utility in patients with unfavourable intermediate-risk disease and ISUP GG 3 appears limited.

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Cite

BibTeXRIS
BibTeX
@article{madsen2026risk,
  title = {{Risk of bone metastases on [18F]NaF PET/CT in 734 patients with newly diagnosed prostate cancer}},
  author = {Claus Madsen and Helle D. Zacho and Rasmus Bisbjerg and Dan Fuglø and Peter B. Østergren},
  journal = {European Journal of Nuclear Medicine and Molecular Imaging},
  year = {2026},
  month = sep,
  doi = {10.1007/s00259-026-08148-y},
  url = {https://doi.org/10.1007/s00259-026-08148-y},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Risk of bone metastases on [18F]NaF PET/CT in 734 patients with newly diagnosed prostate cancer
AU  - Claus Madsen
AU  - Helle D. Zacho
AU  - Rasmus Bisbjerg
AU  - Dan Fuglø
AU  - Peter B. Østergren
PY  - 2026
DA  - 2026/09/05
JO  - European Journal of Nuclear Medicine and Molecular Imaging
DO  - 10.1007/s00259-026-08148-y
UR  - https://doi.org/10.1007/s00259-026-08148-y
AB  - Purpose: International guidelines recommend assessment for bone metastases in patients with high-risk prostate cancer (PC) and those with unfavourable intermediate-risk disease. These recommendations are largely based on studies using planar bone scintigraphy. We aimed to assess the diagnostic accuracy of [18F]sodium fluoride ([18F]NaF) PET/CT in newly diagnosed PC. We also evaluated the clinical utility of routine bone imaging in patients with unfavourable intermediate-risk disease and International Society of Urological Pathology grade group (ISUP GG) 3.  Methods: This retrospective single-center study included 734 consecutive patients with newly diagnosed PC who underwent [18F]NaF PET/CT for primary staging. Patients were classified according to the current European Association of Urology risk classification, with the intermediate-risk subgroup restricted to patients with ISUP GG 3. All scan reports were retrospectively reviewed, and patient-level findings regarding bone metastases were validated against a reference standard based on follow-up imaging and clinical data. Sensitivity, specificity, and predictive values were calculated.  Results: Of the 734 patients, 607 (83%) had high-risk disease and 127 (17%) had intermediate-risk disease with ISUP GG 3. Overall, bone metastases were detected in 225 patients (31%). Among high-risk patients, 224 (37%) had bone metastases, whereas only 1 of 127 intermediate-risk patients (0.8%) had bone metastases on [18F]NaF PET/CT. Follow-up identified one additional potential false-negative case in the intermediate-risk group. Among patients with a conclusive reference standard (n = 689), sensitivity and specificity were 0.90 and 0.99, respectively.  Conclusion: [18F]NaF PET/CT demonstrates high diagnostic accuracy for the detection of bone metastases in newly diagnosed PC. However, given the very low prevalence of bone metastases, its clinical utility in patients with unfavourable intermediate-risk disease and ISUP GG 3 appears limited.
SN  - 1619-7070
SN  - 1619-7089
ER  -