Objective:

To evaluate the feasibility of a dual-parameter approach for opportunistic bone health assessment in prostate cancer using 18F-NaF PET/CT.

Approach:

• Study Design: Retrospective cross-sectional study involving 105 men with prostate cancer without bone metastasis who underwent 18F-NaF PET/CT. Stand-alone diagnostic CT-L1 was available in 76 patients and served as an external structural reference for feasibility analysis.
• Data Analysis: Patient-level analyses used mean lumbar SUVavg and mean PET/CT-derived trabecular attenuation across L1-L4; vertebra-level analyses used same-level measurements.

Key Findings:

• Strong correlation between PET/CT-derived L1 trabecular attenuation and stand-alone diagnostic CT-L1 (correlation coefficient 0.929).
• Adding SUV to low-dose CT did not improve performance for low diagnostic CT-L1 thresholds.
• Among patients in the diagnostic CT gray zone, 46.3% were classified as low 18F-NaF uptake.
• Mean SUVavg correlated positively with mean PET/CT-derived trabecular attenuation (r = 0.521, p<0.001).
• Nine patients exhibited a higher trabecular attenuation but low uptake phenotype.

Interpretation:

18F-NaF PET/CT may support opportunistic bone health assessment by integrating structural and metabolic data.

Limitations:

• Findings are hypothesis-generating and require prospective validation against DXA and fracture endpoints.
• Study design is retrospective, which may introduce bias.

Conclusion:

The study indicates that 18F-NaF PET/CT could be a tool for opportunistic bone health assessment in prostate cancer, pending further validation.