Head-To-Head Comparison of 68Ga-PSMA-11 PET/CT and 99mTc-MDP Bone Scintigraphy for the Detection of Bone Metastases in Patients With Prostate Cancer: A Meta-Analysis.

BACKGROUND. Bone scintigraphy (BS) using 99mTc-labeled methylene diphospho-nate (99mTc-MDP) remains the recommended imaging modality for the detection of bone metastases in patients with prostate cancer (PCa). However, PET/CT using prostate-specific membrane antigen (PSMA) ligands is increasingly recognized as a means of evaluating disease extent in patients with PCa, including use as a possible stand-alone test in high-risk patients. OBJECTIVE. The purpose of this study is to compare the diagnostic performance of 68Ga-PSMA-11 PET/CT with that of 99mTc-MDP BS for the detection of bone metastases in patients with PCa. EVIDENCE ACQUISITION. The PubMed, Embase, and Cochrane Library databases were searched through October 2021 to identify studies reporting a head-to-head comparison of 68Ga-PSMA-11 PET/CT and 99mTc-MDP BS for the detection of bone metastases in patients with PCa. Only studies with a well-defined reference standard (including various combinations of imaging and/or clinical follow-up) were included. Pooled diagnostic performance was calculated using a bivariate random-effects model, and an AUC was derived for each test from hierarchic summary ROC analysis. The complementary roles of the two tests in identifying bone metastases in patients in whom one of the tests was negative were summarized. EVIDENCE SYNTHESIS. Six studies with 546 patients were included. Pooled sensitivity and specificity, respectively, were 98% (95% CI, 94-99%) and 97% (95% CI, 91-99%) for 68Ga-PSMA-11 PET/CT versus 83% (95% CI, 69-91%) and 68% (95% CI, 41-87%) for 99mTc-MDP BS. The AUC was 0.99 (95% CI, 0.96-1.00) for 68Ga-PSMA-11 PET/CT and 0.85 (95% CI, 0.81-0.87) for 99mTc-MDP BS. Among 408 patients from five included studies, 68Ga-PSMA-11 PET/CT correctly identified bone metastases in 43 of 193 patients (22.3%) with negative 99mTc-MDP BS results, whereas 99mTc-MDP BS correctly identified bone metastases in four of 210 patients (1.9%) with negative 68Ga-PSMA-11 PET/CT results. CONCLUSION. On a per-patient basis, the diagnostic performance of 68Ga-PSMA-11 PET/CT is superior to that of 99mTc-MDP BS for the detection of PCa bone metastases. Furthermore, 99mTc-MDP BS offers limited additional information in patients with negative 68Ga-PSMA-11 PET/CT results. CLINICAL IMPACT. According to current evidence, 99mTc-MDP BS is highly unlikely to be additive to 68Ga-PSMA-11 PET/CT in identifying bone metastases in patients with PCa.

[Efficacy of biofeedback and electrical stimulation therapy combined with Sabale capsules for chronic prostatitis / chronic pelvic pain syndrome].

Objective: To investigate the clinical effect of biofeedback and electrical stimulation therapy (BFES) combined with Sabale capsules (SC) on chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS). METHODS: A total of 140 outpatients meeting CP/CPPS diagnostic and research criteria in the Second Affiliated Hospital of Xi'an Jiaotong University were randomly divided into groups A (blank control), B (BFES intervention), C (SC intervention) and D (BFES+SC intervention), 35 cases in each group. The patients in group A were left untreated, while those in groups B, C and D received BFES, SC and BFES+SC, respectively, all for 12 weeks. Then the patients were followed up at 30 days after treatment and the urinary flow rate and NIH-CPSI scores were obtained and compared with the baseline. RESULTS: In comparison with the baseline, the total NIH-CPSI scores after intervention were significantly decreased in groups B, (ï¼»27.30 ± 2.44ï¼½ vs ï¼»19.43 ± 2.33ï¼½), C (ï¼»26.77 ± 2.54ï¼½ vs ï¼»19.40 ± 2.75ï¼½) and D (ï¼»27.67 ± 3.69ï¼½ vs ï¼»15.57 ± 1.94ï¼½) (all P < 0.05), and so were the individual item scores in pain or discomfort (ï¼»12.50 ± 1.94ï¼½ vs ï¼»9.40 ± 2.01ï¼½, ï¼»11.93 ± 1.64ï¼½ vs ï¼»9.23 ± 1.96ï¼½, and ï¼»12.33 ± 2.20ï¼½ vs ï¼»7.50 ± 1.55ï¼½), urination symptoms (ï¼»6.07 ± 1.57ï¼½ vs ï¼»3.83 ± 1.05ï¼½, ï¼»5.97 ± 1.33ï¼½ vs ï¼»3.77 ± 1.14ï¼½, and ï¼»6.20 ± 1.88ï¼½ vs ï¼»2.87 ± 0.94ï¼½), quality of life (QOL) (ï¼»8.73 ± 1.62ï¼½ vs ï¼»6.20 ± 1.42ï¼½, ï¼»8.87 ± 1.25ï¼½ vs ï¼»6.40 ± 1.59ï¼½, and ï¼»9.13 ± 1.70ï¼½ vs ï¼»5.20 ± 1.40ï¼½) (all P < 0.05), while the maximum urinary flow rate (Qmax) was remarkably increased (ï¼»15.72 ± 2.38ï¼½ vs ï¼»19.73 ± 2.85ï¼½, ï¼»16.20 ± 2.44ï¼½ vs ï¼»19.46 ± 2.48ï¼½, and ï¼»15.83 ± 2.52ï¼½ vs ï¼»22.49 ± 2.76ï¼½) (all P < 0.05), and so was the average urinary flow rate (Qavg) (ï¼»9. 282 ± 1.52ï¼½ vs ï¼»11.27 ± 1.95ï¼½, ï¼»8.97 ± 1.25ï¼½ vs ï¼»11.16 ± 1.74ï¼½, and ï¼»9.20 ± 1.36ï¼½ vs ï¼»13.50 ± 2.30ï¼½) (all P < 0.05). The decrease in NIH-CPSI total and item scores and increase in Qmax and Qavg after treatment were more significant in group D than in B and C (P < 0.05), but showed no statistically significant difference between groups B and C (P > 0.05). Nor was any significant change observed in the above parameters in group A after treatment ( P > 0.05). CONCLUSIONS: Biofeedback and electrical stimulation therapy combined with Sabale capsules can alleviate urination dysfunction, pelvic floor tension myalgia and other symptoms and significantly improve the QOL of CP/CPPS patients.

Ureteral Stone Mimicking Abnormal Sacral Uptake on 99mTc MDP Bone Scintigraphy: The Usefulness of SPECT/CT.

Bone tracer uptake related to ureteral stones has been reported several times before. We present a right ureteral stone mimicking abnormal focal sacral uptake on planar scan in a patient with rectal cancer. This case highlights the necessity of performing SPECT/CT to ascertain the origin of abnormal focal sacral uptake on planar scan, especially in patients with a history of kidney stones.