{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T11:43:35Z","timestamp":1777463015611,"version":"3.51.4"},"reference-count":28,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,2,10]],"date-time":"2021-02-10T00:00:00Z","timestamp":1612915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Bone metastases from prostate cancer (PCa) often show an increase in density on computed tomography (CT) after successful androgen deprivation therapy (ADT). Density may be reduced, however, as the disease progresses or, contrarily, when disease is no longer active. The current study investigated the role of 68Ga-PSMA-11 positron emission tomography\/computed tomography (PET\/CT) in differentiating between these two conditions. Methods: The study cohort included 15 PCa patients with sclerotic\/blastic bone metastasis in whom reduction in bone density of metastasis was noted on follow-up 68Ga-PSMA-11 PET\/CT after ADT. Each patient had two PET\/CT scans. Prior to the first scan, six patients were castration na\u00efve and nine patients were already treated. All patients had ADT between the two PET\/CT scans. PET parameters (SUVmax and tumor-to-background ratio), and CT parameters (HUmax) were determined and compared for each lesion on both scans. Patient\u2019s response was based on prostate-specific antigen (PSA) levels and appearance of new lesions. The Kolmogorov\u2013Smirnov test was used to evaluate normal distribution of the continuous variables. Results: Post-ADT reduction in bone density was identified in 37 lesions. The mean HUmax was 883.9 \u00b1 175.1 on the first scan and 395.6 \u00b1 157.1 on the second scan (p &lt; 0.001). Twenty-one of the 37 lesions showed no increased tracer uptake on the second PET\/CT scan raising the likelihood of a response. The other 16 lesions were associated with increased uptake suggestive of an active resistant disease. Bone density was not different in lesions that no longer showed an increased uptake as compared with those that did. Seven of the study patients responded to therapy, and none of the 16 lesions found in these patients showed increased 68Ga-PSMA-11 uptake. In eight patients with progressive disease, all 12 lesions in five of them showed increased 68Ga-PSMA-11 uptake, there was mixed response in two patients (having two lesions with increased uptake and one without) and although all three lesions no longer showed an increased uptake, new lesions were detected in the eighth patient. Conclusion: A decrease in density of bone lesions may reflect clinical progression, or contrarily, a response to therapy in patients with PCa and skeletal involvement treated with ADT. Uptake of 68Ga-PSMA-11 may separate between these two vastly opposing conditions.<\/jats:p>","DOI":"10.3390\/diagnostics11020277","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T00:49:26Z","timestamp":1613090966000},"page":"277","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["68Ga-PSMA-11 PET\/CT Follow-Up of Patients with Prostate Cancer with Bone Metastases Who Had Reduced Bone Density after Androgen Deprivation Therapy"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0786-084X","authenticated-orcid":false,"given":"Mikhail","family":"Kesler","sequence":"first","affiliation":[{"name":"Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ido","family":"Druckmann","sequence":"additional","affiliation":[{"name":"Department of Radiology\u2014Musculoskeletal Imaging Unit, Imaging Division, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Levine","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Kuten","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ofer","family":"Yossepowitch","sequence":"additional","affiliation":[{"name":"Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Einat","family":"Even-Sapir","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1053\/hp.2000.6698","article-title":"Metastatic patterns of prostate cancer: An autopsy study of 1589 patients","volume":"31","author":"Bubendorf","year":"2000","journal-title":"Hum. Pathol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2114","DOI":"10.1007\/s00259-016-3435-0","article-title":"Comparison of bone scintigraphy and 68Ga-PSMA PET for skeletal staging in prostate cancer","volume":"43","author":"Pyka","year":"2016","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.clgc.2018.07.009","article-title":"68Ga-PSMA PET\/CT Replacing Bone Scan in the Initial Staging of Skeletal Metastasis in Prostate Cancer: A Fait Accompli?","volume":"16","author":"Lengana","year":"2018","journal-title":"Clin. Genitourin. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"405","DOI":"10.2967\/jnumed.119.230318","article-title":"Total-Body 68Ga-PSMA-11 PET\/CT for Bone Metastasis Detection in Prostate Cancer Patients: Potential Impact on Bone Scan Guidelines","volume":"61","author":"Pomykala","year":"2020","journal-title":"J. Nucl. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s13550-020-00618-0","article-title":"Added value of 68Ga-PSMA PET\/CT for the detection of bone metastases in patients with newly diagnosed prostate cancer and a previous 99mTc bone scintigraphy","volume":"10","author":"Zacho","year":"2020","journal-title":"EJNMMI Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1007\/s00259-017-3711-7","article-title":"Diagnostic performance of 68Ga-PSMA-11 (HBED-CC) PET\/CT in patients with recurrent prostate cancer: Evaluation in 1007 patients","volume":"44","author":"Giesel","year":"2017","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"434","DOI":"10.2967\/jnumed.117.202945","article-title":"Impact of68Ga-PSMA-11 PET\/CT on the Management of Prostate Cancer Patients with Biochemical Recurrence","volume":"59","author":"Calais","year":"2017","journal-title":"J. Nucl. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1001\/jamaoncol.2019.0096","article-title":"Assessment of 68Ga-PSMA-11 PET Accuracy in Localizing Recurrent Prostate Cancer","volume":"5","author":"Fendler","year":"2019","journal-title":"JAMA Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1093\/annonc\/mdv257","article-title":"Management of patients with advanced prostate cancer: Recommendations of the St Gallen Advanced Prostate Cancer Consensus Conference (APCCC) 2015","volume":"26","author":"Gillessen","year":"2015","journal-title":"Ann. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s10555-017-9719-4","article-title":"Current perspectives on bone metastases in castrate-resistant prostate cancer","volume":"37","author":"Logothetis","year":"2018","journal-title":"Cancer Metastasis Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2942","DOI":"10.1200\/JCO.2004.08.181","article-title":"Bone Imaging in Metastatic Breast Cancer","volume":"22","author":"Hamaoka","year":"2004","journal-title":"J. Clin. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1148\/radiol.2471070567","article-title":"Bone Metastases in Patients with Metastatic Breast Cancer: Morphologic and Metabolic Monitoring of Response to Systemic Therapy with Integrated PET\/CT","volume":"247","author":"Tateishi","year":"2008","journal-title":"Radiology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1007\/s00259-018-4223-9","article-title":"Prediction of therapy response in bone-predominant metastatic breast cancer: Comparison of [18F] fluorodeoxyglucose and [18F]-fluoride PET\/CT with whole-body MRI with diffusion-weighted imaging","volume":"46","author":"Azad","year":"2018","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13550-019-0554-1","article-title":"[68Ga]Ga-PSMA-11 PET\/CT for monitoring response to treatment in metastatic prostate cancer: Is there any added value over standard follow-up?","volume":"9","author":"Kuten","year":"2019","journal-title":"EJNMMI Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.urology.2006.11.002","article-title":"Prevalence of Osteoporosis During Long-Term Androgen Deprivation Therapy in Patients with Prostate Cancer","volume":"69","author":"Morote","year":"2007","journal-title":"Urology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1002\/cncr.27830","article-title":"Bone density testing among prostate cancer survivors treated with androgen-deprivation therapy","volume":"119","author":"Morgans","year":"2013","journal-title":"Cancer"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40644-016-0072-6","article-title":"68Ga-PSMA ligand PET\/CT in patients with prostate cancer: How we review and report","volume":"16","author":"Rauscher","year":"2016","journal-title":"Cancer Imaging"},{"key":"ref_18","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_19","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1530\/ERC-14-0199","article-title":"Castration-induced bone loss triggers growth of disseminated prostate cancer cells in bone","volume":"21","author":"Ottewell","year":"2014","journal-title":"Endocr. Relat. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2545","DOI":"10.1002\/ijc.26024","article-title":"Steps in prostate cancer progression that lead to bone metastasis","volume":"128","author":"Jin","year":"2011","journal-title":"Int. J. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1200\/JCO.2007.12.4487","article-title":"Design and End Points of Clinical Trials for Patients with Progressive Prostate Cancer and Castrate Levels of Testosterone: Recommendations of the Prostate Cancer Clinical Trials Working Group","volume":"26","author":"Scher","year":"2008","journal-title":"J. Clin. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1038\/sj.bjc.6605546","article-title":"Tumour response interpretation with new tumour response criteria vs the World Health Organisation criteria in patients with bone-only metastatic breast cancer","volume":"102","author":"Hamaoka","year":"2010","journal-title":"Br. J. Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1007\/s11307-009-0217-0","article-title":"The Use of F-18 Choline PET in the Assessment of Bone Metastases in Prostate Cancer: Correlation with Morphological Changes on CT","volume":"11","author":"Beheshti","year":"2009","journal-title":"Mol. Imaging Biol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.2967\/jnumed.117.207373","article-title":"A Prospective Comparison of 18F-Sodium Fluoride PET\/CT and PSMA-Targeted 18F-DCFBC PET\/CT in Metastatic Prostate Cancer","volume":"59","author":"Harmon","year":"2018","journal-title":"J. Nucl. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.2214\/ajr.142.6.1175","article-title":"Lysis of osteoblastic lesions in prostatic cancer: A sign of progression","volume":"142","author":"Pollen","year":"1984","journal-title":"Am. J. Roentgenol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"799","DOI":"10.2967\/jnumed.119.234260","article-title":"Molecular Imaging of Bone Metastases and Their Response to Therapy","volume":"61","author":"Cook","year":"2020","journal-title":"J. Nucl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1007\/s00259-018-3936-0","article-title":"68Ga-PSMA PET\/CT in the evaluation of bone metastases in prostate cancer","volume":"45","author":"Sachpekidis","year":"2018","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1007\/s00256-019-03230-z","article-title":"Comparison of PSMA-PET\/CT, choline-PET\/CT, NaF-PET\/CT, MRI, and bone scintigraphy in the diagnosis of bone metastases in patients with prostate cancer: A systematic review and meta-analysis","volume":"48","author":"Zhou","year":"2019","journal-title":"Skelet. Radiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/2\/277\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:22:39Z","timestamp":1760160159000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/2\/277"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,10]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["diagnostics11020277"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics11020277","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,10]]}}}