Bone metastases in prostate cancer (PCa) have important prognostic significance, and imaging modalities used for PCa staging should have high sensitivity for detecting such lesions. Prostate-specific membrane antigen (PSMA)–targeted PET radiotracers are promising new agents for imaging PCa. We undertook a head-to-head comparison of PSMA-targeted 2-(3-{1-carboxy-5-[(6-¹⁸F-fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (¹⁸F-DCFPyL) PET to Na¹⁸F PET to determine which modality was more sensitive for the detection of lesions suggestive of bone metastases in a group of patients with metastatic PCa. Methods: Patients with progressive, metastatic PCa were prospectively imaged with both ¹⁸F-DCFPyL and Na¹⁸F PET/CT, with both scans occurring within 24 h of each other. A consensus 2-reader central review was performed to identify all bone lesions suggestive of sites of PCa involvement on both scans, and maximized SUVs corrected for body weight (SUV_max) and lean body mass (SUL_max) were recorded. Soft-tissue lesions were also noted on both scans, and SUV_max, SUL_max, and PSMA reporting and data system (RADS) version 1.0 scores were recorded. Data from the 2 scans were compared using a generalized estimating equation. Results: In total, 16 patients meeting all inclusion criteria were enrolled in this study, and 15 of the 16 (93.8%) were imaged with both PET radiotracers. In total, 405 bone lesions suggestive of sites of PCa were identified on at least 1 scan. On ¹⁸F-DCFPyL PET/CT, 391 (96.5%) were definitively positive, 4 (1.0%) were equivocally positive, and 10 (2.5%) were negative. On Na¹⁸F PET/CT, the corresponding values were 388 (95.8%), 4 (1.0%), and 13 (3.2%). Of the definitively negative lesions on ¹⁸F-DCFPyL PET, 8 of 10 (80.0%) were sclerotic and 2 of 10 (20.0%) were infiltrative or marrow-based. Additionally, 12 of 13 (92.3%) of the definitively negative lesions on Na¹⁸F PET were infiltrative or marrow-based and 1 of 13 (7.7%) was lytic. Also identified were 78 PSMA-RADS-4, 17 PSMA-RADS-5, and 1 PSMA-RADS-3C soft-tissue lesions. Conclusion: PET/CT imaging using ¹⁸F-DCFPyL and Na¹⁸F PET had nearly identical sensitivities for the detection of bone lesions in patients with metastatic PCa. As would be expected, PSMA-targeted PET provides more information on soft-tissue disease. There may be little additional value to imaging PCa patients with Na¹⁸F after a PSMA-targeted PET scan has already been performed.

前列腺癌（PCa）的骨转移具有重要的预后意义，用于PCa分期的影像学方法对检测此类病变应具有较高的敏感性。前列腺特异性膜抗原（PSMA）靶向PET放射性示踪剂是用于PCa成像的有前途的新型药物。我们进行了以PSMA为目标的2-（3- {1-羧基-5-[（6- ¹⁸ F-氟吡啶-3-羰基）-氨基]-戊基}-脲基）-脲的面对面比较戊二酸（¹⁸ F-DCFPyL）PET对Na ¹⁸ F PET的确定，以确定哪种模式对检测转移性PCa患者的暗示骨转移的病变更敏感。方法：对前移性转移性PCa患者进行前瞻性成像，包括¹⁸F-DCFPyL和Na ¹⁸ F PET / CT，两次扫描均在24小时内进行。进行了共识性的2位读者中央检查，确定了两次扫描均提示PCa累及部位的所有骨病变，并记录了经校正的最大SUV体重（SUV _max）和瘦体重（SUL _max）。两次扫描也都记录了软组织病变，并且记录了SUV _max，SUL _max以及PSMA报告和数据系统（RADS）1.0版得分。使用广义估计方程比较两次扫描的数据。结果：总共有16名符合所有入选标准的患者参加了这项研究，并且在这16名患者中有15名（93.8％）使用了两种PET放射性示踪剂进行了成像。在至少1次扫描中，总共发现405个提示PCa部位的骨病变。在¹⁸ F-DCFPyL PET / CT上，确定为阳性的有391（96.5％），明确为阳性的有4（1.0％），为阴性的有10（2.5％）。在Na ¹⁸ F PET / CT上，相应的值为388（95.8％），4（1.0％）和13（3.2％）。在¹⁸ F-DCFPyL PET上确定的阴性病变中，硬化中有8个（占80.0％），浸润性或骨髓性占10个中的2个（占20.0％）。此外，在Na ¹⁸上，有13例最终阴性病变中有12例（92.3％）F PET是浸润性的或基于骨髓的，并且13分之一（7.7％）是溶解性的。还确定了78个PSMA-RADS-4、17个PSMA-RADS-5和1个PSMA-RADS-3C软组织病变。结论：使用¹⁸ F-DCFPyL和Na ¹⁸ F PET进行PET / CT成像对转移性PCa患者的骨病变检测灵敏度几乎相同。不出所料，以PSMA为靶标的PET可提供有关软组织疾病的更多信息。在已经进行了针对PSMA的PET扫描后，对Na ¹⁸ F的PCa患者进行成像可能没有什么附加价值。