title: Impact of 18F-fluoride PET in patients with known prostate cancer: initial results from the National Oncologic PET Registry.
abstract: Under Medicare's Coverage with Evidence Development policy, PET using (18)F-sodium fluoride (NaF PET) to identify osseous metastasis became a covered service if prospective registry data were collected. The National Oncologic PET Registry (NOPR) developed a NaF PET registry built on the foundation of its prior registry for PET with (18)F-FDG. Men with prostate cancer represented 72% of the cases.
  
  
  METHODS
  Prospective data before and after NaF PET were collected from referring and interpreting physicians. The analysis set consisted of consenting men age 65 y or older with prostate cancer undergoing NaF PET for initial staging (IS, n = 1,024), suspected first osseous metastasis (FOM, n = 1,997), or suspected progression of osseous metastasis (POM, n = 510).
  
  
  RESULTS
  Referring physicians indicated that if NaF PET were not available, other advanced imaging (body CT, MR imaging, or (18)F-FDG PET) would be their plan in about half of the cases. After NaF PET, the postimaging plan was revised to treatment in 77%, 52%, and 71% for IS, FOM, and POM, respectively. When intended management was classified as either treatment or nontreatment, the overall change in intended management ranged from 44% to 52% and from 12% to 16% if no effect was assumed for those cases with pre-PET plans for other imaging (imaging-adjusted impact). Interpreting physicians recorded definite findings of bone metastasis in 14%, 29%, and 76% for IS, FOM, and POM, respectively. The intended care patterns varied widely across indication and scan abnormality category combinations.
  
  
  CONCLUSIONS
  NaF PET has high overall impact, principally related to its effect on replacing intended use of other advanced imaging. Its imaging-adjusted impact was similar to that observed with (18)F-FDG PET for restaging or suspected recurrence in other cancer types.
authors.affiliation: Department of Internal Medicine and the Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Hillner
authors.forename: Barry A
authors.initials: BA
authors.lastname: Siegel
authors.forename: Lucy
authors.initials: L
authors.lastname: Hanna
authors.forename: Fenghai
authors.initials: F
authors.lastname: Duan
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Shields
authors.forename: R Edward
authors.initials: RE
authors.lastname: Coleman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000639:trends*; D009364:Neoplasm Recurrence, Local; D049268:Positron-Emission Tomography; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D019275:Radiopharmaceuticals; D012042:Registries; D012969:Sodium Fluoride; D014057:Tomography, X-Ray Computed; D014481:United States
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D012969:Sodium Fluoride
keywords: PET; bone scintigraphy; prospective studies; prostate cancer; registry