{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T12:50:48Z","timestamp":1774615848044,"version":"3.50.1"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Precise staging of prostate cancer is vital for treatment planning and prognosis. While [68Ga]Ga-PSMA-11 PET-CT has demonstrated high diagnostic accuracy in detecting metastatic disease, the interpretation of indeterminate or potentially benign PSMA-avid bone lesions remains a clinical challenge in routine practice. Methods: We conducted a retrospective single-centre study involving 214 patients who underwent [68Ga]Ga-PSMA-11 PET-CT between January 2021 and January 2024. Patients with prior known bone metastases or alternative PSMA radiotracers were excluded. Only those with follow-up imaging were included for diagnostic accuracy analysis. Follow-up modalities included PSMA PET-CT, CT, MRI, and bone scintigraphy. Final classification (metastatic or benign) was based on radiological and clinical assessment. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using follow-up imaging as the reference standard. Lesions classified as indeterminate were analysed separately and excluded from diagnostic performance calculations. Results: Of the 214 included patients, 142 had follow-up imaging. Among 80 patients with bone lesions initially reported as metastatic, 74 (92.5%) were confirmed. Among 28 patients initially reported as having benign bone lesions, 26 (92.9%) remained benign on follow-up. Thirty-four patients with indeterminate lesions were reviewed; four were ultimately metastatic. Excluding indeterminate cases, sensitivity, specificity, PPV, and NPV were 97.4%, 86.7%, 94.9%, and 92.9%, respectively. Diagnostic discordance was primarily associated with benign uptake in the ribs, iliac bones, pubic rami and degenerative changes. Conclusions: [68Ga]Ga-PSMA-11 PET-CT shows excellent sensitivity and positive predictive value for detecting metastatic bone disease in prostate cancer. However, benign lesions may also exhibit uptake, emphasising the importance of integrating imaging results with PSA levels, Gleason scores, and TNM staging. Prospective studies are needed to validate these findings and assess their impact on long-term outcomes.<\/jats:p>","DOI":"10.3390\/cancers18071090","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T11:32:47Z","timestamp":1774611167000},"page":"1090","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Accuracy of [68Ga]Ga-PSMA-11 PET-CT in Characterising Bone Lesions in Prostate Cancer: A Single-Centre Study"],"prefix":"10.3390","volume":"18","author":[{"given":"Aishani","family":"Sachdeva","sequence":"first","affiliation":[{"name":"Guys and St. Thomas NHS Trust, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mona","family":"Salem","sequence":"additional","affiliation":[{"name":"Guys and St. Thomas NHS Trust, London SE1 7EH, UK"},{"name":"Department of Clinical Oncology, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11956, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Guys and St. Thomas NHS Trust, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle","family":"Wong","sequence":"additional","affiliation":[{"name":"Guys and St. Thomas NHS Trust, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8732-8134","authenticated-orcid":false,"given":"Gary J. R.","family":"Cook","sequence":"additional","affiliation":[{"name":"Guys and St. Thomas NHS Trust, London SE1 7EH, UK"},{"name":"The School of Biomedical Engineering and Imaging Sciences, Kings College London, St. Thomas Hospital, Westminster Bridge Road, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5373-1777","authenticated-orcid":false,"given":"Gurdip","family":"Azad","sequence":"additional","affiliation":[{"name":"Guys and St. Thomas NHS Trust, London SE1 7EH, UK"},{"name":"The School of Biomedical Engineering and Imaging Sciences, Kings College London, St. Thomas Hospital, Westminster Bridge Road, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ref_1","unstructured":"(2025, September 09). Cancer Research UK. Available online: https:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics\/statistics-by-cancer-type\/prostate-cancer#heading-One."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.2967\/jnumed.121.263124","article-title":"Oligometastatic prostate cancer: Current status and future challenges","volume":"63","author":"Jadvar","year":"2022","journal-title":"J. Nucl. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Tsechelidis, I., and Vrachimis, A. (2022). PSMA PET in imaging prostate cancer. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.831429"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1016\/S0140-6736(20)30314-7","article-title":"Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): A prospective, randomised, multicentre study","volume":"395","author":"Hofman","year":"2020","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.eururo.2019.01.049","article-title":"Gallium-68 prostate-specific membrane antigen positron emission tomography in advanced prostate cancer\u2014Updated diagnostic utility, sensitivity, specificity, and distribution of prostate-specific membrane antigen-avid lesions: A systematic review and meta-analysis","volume":"77","author":"Perera","year":"2020","journal-title":"Eur. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1007\/s00259-019-04643-7","article-title":"The management impact of 68gallium-tris (hydroxypyridinone) prostate-specific membrane antigen (68Ga-THP-PSMA) PET-CT imaging for high-risk and biochemically recurrent prostate cancer","volume":"47","author":"Kulkarni","year":"2020","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"7448","DOI":"10.1158\/1078-0432.CCR-19-1050","article-title":"Prostate-specific membrane antigen ligand positron emission tomography in men with nonmetastatic castration-resistant prostate cancer","volume":"25","author":"Fendler","year":"2019","journal-title":"Clin. Cancer Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1590\/0100-3984.2023.0003","article-title":"Musculoskeletal pitfalls in 68Ga-PSMA PET\/CT","volume":"56","author":"Pontes","year":"2023","journal-title":"Radiol. Bras."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.crad.2024.05.013","article-title":"Prostate specific membrane antigen (PSMA) avid nonprostatic benign and malignant disease: A pictorial review","volume":"79","author":"Srinivasan","year":"2024","journal-title":"Clin. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.2967\/jnumed.118.209387","article-title":"Potential impact of 68Ga-PSMA-11 PET\/CT on the planning of definitive radiation therapy for prostate cancer","volume":"59","author":"Calais","year":"2018","journal-title":"J. Nucl. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Orevi, M., Ben-Haim, S., Abourbeh, G., Chicheportiche, A., Mishani, E., Yutkin, V., and Gofrit, O.N. (2022). False positive findings of [18F] PSMA-1007 PET\/CT in patients after radical prostatectomy with undetectable serum PSA levels. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.943760"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1111\/bju.15152","article-title":"Solitary rib lesions showing prostate-specific membrane antigen (PSMA) uptake in pre-treatment staging 68Ga-PSMA-11 positron emission tomography scans for men with prostate cancer: Benign or malignant?","volume":"126","author":"Chen","year":"2020","journal-title":"BJU Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1038\/s41391-023-00755-2","article-title":"Comparison of 18F-based PSMA radiotracers with [68Ga] Ga-PSMA-11 in PET\/CT imaging of prostate cancer\u2014A systematic review and meta-analysis","volume":"27","author":"Huang","year":"2024","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1007\/s00259-021-05520-y","article-title":"Prospective intra-individual blinded comparison of [18F] PSMA-1007 and [68 Ga] Ga-PSMA-11 PET\/CT imaging in patients with confirmed prostate cancer","volume":"49","author":"Pattison","year":"2022","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3910","DOI":"10.1007\/s00259-022-05745-5","article-title":"Assessment of malignancy and PSMA expression of uncertain bone foci in [18F] PSMA-1007 PET\/CT for prostate cancer\u2014A single-centre experience of PET-guided biopsies","volume":"49","author":"Vollnberg","year":"2022","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s13550-023-00981-8","article-title":"Multiparametric dynamic whole-body PSMA PET\/CT using [68Ga] Ga-PSMA-11 and [18F] PSMA-1007","volume":"13","author":"Dias","year":"2023","journal-title":"EJNMMI Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3610","DOI":"10.1007\/s00261-023-04002-z","article-title":"PSMA PET imaging in the diagnosis and management of prostate cancer","volume":"48","author":"Houshmand","year":"2023","journal-title":"Abdom. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.eururo.2017.10.027","article-title":"PSMA-RADS version 1.0: A step towards standardizing the interpretation and reporting of PSMA-targeted PET imaging studies","volume":"73","author":"Rowe","year":"2017","journal-title":"Eur. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.eururo.2023.06.008","article-title":"Prostate-specific membrane antigen reporting and data system version 2.0","volume":"84","author":"Werner","year":"2023","journal-title":"Eur. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"386","DOI":"10.2214\/AJR.21.27323","article-title":"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","volume":"219","author":"Zhao","year":"2022","journal-title":"Am. J. Roentgenol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.jmir.2023.04.005","article-title":"The diagnostic accuracy of 68Ga-PSMA PET\/CT versus 99mTc-MDP bone scintigraphy for identifying bone metastases in persons with prostate cancer: A systematic review","volume":"54","author":"Daniels","year":"2023","journal-title":"J. Med. Imaging Radiat. Sci."},{"key":"ref_22","first-page":"104.e17","article-title":"Accuracy of 68Ga-PSMA PET\/CT for lymph node and bone primary staging in prostate cancer","volume":"40","author":"Moreira","year":"2022","journal-title":"Urol. Oncol. Semin. Orig. Investig."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1007\/s00259-017-3631-6","article-title":"68Ga-PSMA-11 PET\/CT in primary staging of prostate cancer: PSA and Gleason score predict the intensity of tracer accumulation in the primary tumour","volume":"44","author":"Uprimny","year":"2017","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.euo.2020.01.002","article-title":"Detection of recurrent prostate cancer using prostate-specific membrane antigen positron emission tomography in patients not meeting the Phoenix criteria for biochemical recurrence after curative radiotherapy","volume":"4","author":"Jansen","year":"2021","journal-title":"Eur. Urol. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.euros.2023.12.001","article-title":"The probability of metastases within different prostate-specific antigen ranges using prostate-specific membrane antigen positron emission tomography in patients with newly diagnosed prostate cancer","volume":"59","author":"Luining","year":"2024","journal-title":"Eur. Urol. Open Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1038\/s41585-022-00670-6","article-title":"Using PSMA imaging for prognostication in localized and advanced prostate cancer","volume":"20","author":"Roberts","year":"2023","journal-title":"Nat. Rev. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"786","DOI":"10.2967\/jnumed.118.219501","article-title":"Metaanalysis of 68Ga-PSMA-11 PET accuracy for the detection of prostate cancer validated by histopathology","volume":"60","author":"Hope","year":"2019","journal-title":"J. Nucl. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1097\/MOU.0000000000001169","article-title":"Metastasis-directed therapy in oligometastatic prostate cancer","volume":"34","author":"Miszczyk","year":"2024","journal-title":"Curr. Opin. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2117","DOI":"10.1007\/s00259-017-3780-7","article-title":"Pearls and pitfalls in clinical interpretation of prostate-specific membrane antigen (PSMA)-targeted PET imaging","volume":"44","author":"Sheikhbahaei","year":"2017","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1007\/s00259-017-3718-0","article-title":"Effects of arm truncation on the appearance of the halo artifact in 68Ga-PSMA-11 (HBED-CC) PET\/MRI","volume":"44","author":"Wolf","year":"2017","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/7\/1090\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T11:54:52Z","timestamp":1774612492000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/7\/1090"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["cancers18071090"],"URL":"https:\/\/doi.org\/10.3390\/cancers18071090","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]}}}