title: Fluorocholine (18F) and sodium fluoride (18F) PET/CT in the detection of prostate cancer: prospective comparison of diagnostic performance determined by masked reading.
abstract: OBJECTIVE
  The aim of this paper was to compare the diagnostic performance of positron emission tomography/computed tomography (PET/CT) with fluorocholine (18F) (FCH) or fluoride(18F) (FNa) for the detection of bone metastasis in patients with prostate cancer complaining from osteoarticular pain, taking into account whether they were referred for initial staging or recurrence localization. The initial hypothesis was that FCH site-based specificity would be superior to that of F Na, with no loss in sensitivity.
  
  
  METHODS
  Forty-two patients were enrolled in this prospective study, underwent both PET/CTs and were then followed-up for at least 6 months. The standard of truth (SOT) about the presence/absence and location of bone metastasis could be determined in 40 patients, by 2 independent medical assessors, blinded to the results of both PET/CTs. The comparison was performed according to the guideline of the European Medicines Agency, i.e. based on the results of blind reading with SOT as reference.
  
  
  RESULTS
  Bone extension was present in 22 patients and absent in 18. Patient-based performance for FCH vs. FNa was 91% vs. 91% for sensitivity, 89% vs. 83% for specificity and 90% vs. 88% for accuracy (no significant difference). Of 360 skeletal sites, 68 were malignant and 292 non-invaded. There was no significant difference in site-based performance in the group of patients referred at initial staging, but in the group of patients referred for suspicion of recurrence, FCH was significantly more specific than FNa (96% vs. 91%, P=0.033 with Obuchowski's correction) while sensitivity was the same, 89%.
  
  
  CONCLUSIONS
  Both radiopharmaceuticals, based on a very different metabolic approach, showed good diagnostic performance. If FCH is available, it should be preferred in patients after initial treatment.
authors: PET-CT Center Linz, St Vincent's Hospital, Linz, Austria.
authors: W
authors: W
authors: Langsteger
authors: S
authors: S
authors: Balogova
authors: V
authors: V
authors: Huchet
authors: M
authors: M
authors: Beheshti
authors: F
authors: F
authors: Paycha
authors: C
authors: C
authors: Egrot
authors: G
authors: G
authors: Janetschek
authors: W
authors: W
authors: Loidl
authors: V
authors: V
authors: Nataf
authors: K
authors: K
authors: Kerrou
authors: O
authors: O
authors: Pascal
authors: O
authors: O
authors: Cussenot
authors: J N
authors: JN
authors: Talbot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D002794:Choline / Q000031:analogs & derivatives*; D005462:Fluorine Radioisotopes; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D012969:Sodium Fluoride; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; C514960:fluorocholine; D012969:Sodium Fluoride; D002794:Choline