Conventional Tc-99m-based Bone Scan Versus Fluoride Positron Emission Tomography Combined with Computed Tomography in the Assessment of Bone Metastases in Prostate Cancer Patients

In prostate cancer, bone metastasis is related to a poor prognosis and is one of the major causes of morbidity and mortality. Detection of metastatic bone disease is particularly important in prostate cancer patients with high probability for distant metastases before embarking on radical prostatectomy or radiation therapy. The choice of imaging modalities that best depict the metastatic bony lesions may vary depending on different patterns of bone metastases. Bone scintigraphy has been used routinely in the evaluation of prostate cancer patients in the last decades. However, it suffers from adequate specificity. Single photon emission tomography (SPECT) increases the sensitivity and specificity of planar bone scanning especially for the evaluation of the spine. Recently, positron emission tomography (PET) using F-18 Fluoride shows promising results in the detection of bone metastases especially in cancers with prominent osteoblasic pattern of bone metastases such as prostate cancer. This article reviews the value of conventional planar bone scanning, SPECT, SPECT/CT as well as F-18 Fluoride PET/CT in the assessment of bone metastases in prostate cancer patients.