How do you incorporate NaF bone scan in the initial workup of prostate cancer?

At this point, I think the field is still learning how to make use of these tests and trying to determine which patients are the best candidates. We clearly need better imaging to detect early metastatic disease and lymph node involvement, as these findings would change how we would approach the patient's treatment. I've been trying to use these newer tests in patients at high risk for having disease outside the prostate, such as those with an intact prostate and high risk disease or salvage the...

I have been using NAF scan in patients who clinically are at high risk and bone scan suggest equivocal oligometastaes before ruling out local treatment. In my limited experience, it has helped, as a significant number of times the findings of bone metastases is confirmed on these scans and we avoid treating these patients with local treatment.

For a rising PSA after surgery, we favor axumin scan which has a high yield specifically when PSA is above .5 and can help identify the site of relapse.

P...

I don't see any role for NaF PET/CT for localized prostate cancer.

We have occasionally used this for post-op patients with non-zero PSA, or those with biochemical recurrence or other strong suspicion for metastatic disease, however results are difficult to interpret because it is so very sensitive especially in patients with arthritis.