• Haider Ali Department of nuclear medicine and molecular imaging, Sindh Institute of Urology & Transplantation, Karachi
  • Syed Rashid Ul Amin Department of nuclear medicine and molecular imaging, Sindh Institute of Urology & Transplantation, Karachi
  • Abdul Hai Department of nuclear medicine and molecular imaging, Sindh Institute of Urology & Transplantation, Karachi
  • Noureen Nizar Department of nuclear medicine and molecular imaging, Sindh Institute of Urology & Transplantation, Karachi



Keywords: Prostate carcinoma, bone metastases, PSMA-PET/CT, Bone scintigraphy


Background: Prostate cancer is the cause of the highest cancer-related death in males, 5-year survival is 31% in metastatic disease, and bone is a common site of metastases. Bone scintigraphy is a routinely used imaging modality for detecting skeletal metastases. It has variable sensitivity of 52–100%, whereas PSMA PET/CT scans have better sensitivity approaching 100%, so we determined the diagnostic accuracy, sensitivity, and specificity of planar M.D.P. (methylene diphosphonate) bone scintigraphy. Methods: This analytical cross-sectional study was conducted at the N.M. & molecular imaging department of S.I.U.T. Karachi. Bone scans and PSMA-PET/CT scans of all patients who were visited from Janury-2018 to January 2023 were reviewed and interpreted by a nuclear physician& radiologist team. Inclusion criteria were histopathology-proven prostate cancer patients who had a bone scan and PSMA PET/CT scan within one month and had not received any treatment between scans. Results: Among 70 scans, 38 (54.2%) were positive for bone lesions. A total of 18 (47%) patients had positive bony lesions on both PSMA-PET/CT and Bone scintigraphy. Among 38 bone lesions positive patients, in eleven patients, bone lesions were detected only on PET/CT scans, whereas nine were positive only on Bone scans. The mean S.U.V. max of all bony lesions was 19.15 (range 3.2–57.5). The bone scan's sensitivity, specificity, and accuracy were 62.07%, 78.05%, and 62.87%, respectively. Conclusion:  PSMA-PET/CT is better than bone Scintigraphy for detecting skeletal metastases. However, outcomes of bone scintigraphy may be improved when Tc-PSMA receptor bone scintigraphy is used.


Sekhoacha M, Riet K, Motloung P, Gumenku L, Adegoke A, Mashele S. Prostate Cancer Review: Genetics, Diagnosis, Treatment Options, and Alternative Approaches. Molecules 2022;27(17):5730.

American Cancer Society. Key Statistics for Prostate Cancer [Internet]. American Cancer Society [cited 2023 April 17]. Available from: Prostate Cancer: Statistics [internet]. American Society of clinical oncology [cited 2023 April 17]. Available from:

Idrees R, Fatima S, Abdul-Ghafar J, Raheem A, Ahmad Z. Cancer prevalence in Pakistan: meta-analysis of various published studies to determine variation in cancer figures resulting from marked population heterogeneity in different parts of the country. World J Surg Oncol 2018;16(1):1–1.

World Life Expectancy. World Health Rankings: Pakistan; Prostate Cancer [internet]. World Life Expectancy [cited 2023 May 31] Available from:

Carlin BI, Andriole GL. The natural history, skeletal complications, and management of bone metastases in patients with prostate carcinoma. Cancer 2000;88(Suppl 12):2989–94.

Coleman RE. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev 2001;27(3):165–76.

Langsteger W, Rezaee A, Pirich C, Beheshti M. 18F-NaF-PET/C.T. and 99mTc-MDP bone scintigraphy in the detection of bone metastases in prostate cancer. Semin Nucl Med 2016;46(6):491–501.

Turpin A, Girard E, Baillet C, Pasquier D, Olivier J, Villers A, et al. Imaging for metastasis in prostate cancer: a review of the literature. Front Oncol 2020;10:55.

Kim YJ, Kim YI. Therapeutic responses and survival effects of 177Lu-PSMA-617 radioligand therapy in metastatic castrate-resistant prostate cancer: a meta-analysis. Clin Nucl Med 2018;43(10):728–34.

Lengana T, Modiselle M, Lawal I, Boshomane G, Ebenhan T, Vorster M, et al. 68Ga-PSMA-PET/C.T. and bone scintigraphy imaging for staging of high-risk prostate cancer. J Nucl Med 2017;58(Suppl 1):757.

Fox JJ, Morris MJ, Larson SM, Schöder H, Scher HI. Developing imaging strategies for castration resistant prostate cancer. Acta Oncol 2011;50(Suppl 1):39–48.

Kikuchi A, Onoguchi M, Horikoshi H, Sjöstrand K, Edenbrandt L. Automated segmentation of the skeleton in whole-body bone scans: influence of difference in atlas. Nucl Med Commun 2012;33(9):947–53.

Schoonjans F. MedCalc. [Internet]. MedCalc’s Diagnostic test evaluation calculator. [cited 2023 April 26]. Available from:

Niikura N, Hashimoto J, Kazama T, Koizumi J, Ogiya R, Terao M, et al. Diagnostic performance of 18 F-fluorodeoxyglucose PET/CT and bone scintigraphy in breast cancer patients with suspected bone metastasis. Breast Cancer 2016;23(4):662–7.

Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 2017;71(4):618–29.

Sartor O, Eisenberger M, Kattan MW, Tombal B, Lecouvet F. Unmet needs in the prediction and detection of metastases in prostate cancer. Oncologist 2013;18(5):549–57.

Lengana T, Lawal IO, Boshomane TG, Popoola GO, Mokoala KM, Moshokoa E, et al. 68Ga-PSMA PET/CT replacing bone scan in the initial staging of skeletal metastasis in prostate cancer: a fait accompli? Clin Genitourin Cancer 2018;16(5):392–401.

Pyka T, Okamoto S, Dahlbender M, Tauber R, Retz M, Heck M, et al. Comparison of bone scintigraphy and 68 Ga-PSMA P.E.T. for skeletal staging in prostate cancer. Eur J Nucl Med Mol Imaging 2016;43(12):2114–21.

Wilson ZJ, Xu G, Tewari SO, Lu Y. Comparison of PSMA-based 18F-DCFPyL PET/CT and Tc-99m M.D.P. bone scan in detection of bone metastasis in prostate cancer. Am J Nucl Med Mol Imaging 2023;13(1):1–10.

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