***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose The aim of our study was to compare the diagnostic performance of 68Ga-PSMA PET and 99mTc bone scintigraphy ( BS ) for the detection of  bone metastases in prostate cancer ( PC ) patients . Methods One hundred twenty-six patients who received planar BS and PSMA PET within three months and without change of therapy were extracted from our data base . Bone lesions were categorized into benign , metastatic , or equivocal by two experienced observers . A best valuable comparator ( BVC ) was defined based on BS , PET , additional imaging , and follow-up data . The cohort was further divided into clinical subgroups ( primary staging , biochemical recurrence , and metastatic castration-resistant prostate cancer [ mCRPC ] ) . Additionally , subgroups of patients with less than 30 days delay between the two imaging procedures and with additional single-photon emission computed tomography ( SPECT ) were analyzed . Results A total of 75 of 126 patients were diagnosed with bone metastases . Sensitivities and specificities regarding overall bone involvement were 98.7–100 % and 88.2–100 % for PET , and 86.7–89.3 % and 60.8–96.1 % ( p < 0.001 ) for BS , with ranges representing results for ‘ optimistic ’ or ‘ pessimistic ’ classification of equivocal lesions . Out of 1115 examined bone regions , 410 showed metastases . Region-based analysis revealed a sensitivity and specificity of 98.8–99.0 % and 98.9–100 % for PET , and 82.4–86.6 % and 91.6–97.9 % ( p < 0.001 ) for BS , respectively . PSMA PET also performed better in all subgroups , except patient-based analysis in mCRPC . Conclusion Ga-PSMA PET outperforms planar BS for the detection of affected bone regions as well as determination of overall bone involvement  in PC patients . Our results indicate that BS in patients who have received PSMA PET for staging only rarely offers additional information ; however , prospect i ve studies , including a st and ardized integrated x-ray computed tomography ( SPECT/CT ) protocol , should be performed in order to confirm the presented results Purpose The aim of this retrospective two-centre study was to investigate the clinical impact of 11C-choline PET/CT on treatment management decisions in patients with recurrent prostate cancer ( rPCa ) after radical therapy .  Methods Enrolled in this retrospective study were 150 patients ( 95 from Bologna , 55 from Würzburg ) with rPCa and biochemical relapse ( PSA mean ± SD 4.3 ± 5.5 ng/mL , range 0.2–39.4 ng/mL ) after radical therapy .  The intended treatment before PET/CT was salvage radiotherapy of the prostatic bed in 95 patients and palliative and rogen deprivation therapy ( ADT ) in 55 patients . The effective clinical impact of 11C-choline PET/CT was rated as major ( change in therapeutic approach ) , minor ( same treatment , but modified therapeutic strategy ) or none . Multivariate binary logistic regression analysis included PSA level , PSA kinetics , ongoing ADT , Gleason score , TNM , age and time to relapse . Results Changes in therapy after 11C-choline PET/CT were implemented in 70 of the 150 patients ( 46.7 % ) . A major clinical impact was observed in 27 patients ( 18 % ) and a minor clinical impact in 43 ( 28.7 % ) . 11C-choline PET/CT  was positive in 109 patients ( 72.7 % ) detecting local relapse ( prostate bed and /or iliac lymph nodes and /or pararectal lymph nodes ) in 64 patients ( 42.7 % ) . Distant relapse ( paraaortic and /or retroperitoneal lymph nodes and /or bone lesions ) was seen in 31 patients ( 20.7 % ) , and both local and distant relapse in 14 ( 9.3 % ) . A significant difference was observed in PSA level and PSA kinetics between PET-positive and PET-negative patients ( p < 0.05 ) . In multivariate analysis , PSA level , PSA doubling time and ongoing ADT were significant predictors of a positive scan ( p < 0.05 ) . In statistical analysis no significant differences were observed between the Bologna and Würzburg patients ( p > 0.05 ) . In both centres the same criteria to vali date PET-positive findings were used : in 17.3 % of patients by histology and in 82.7 % of patients by correlative imaging and /or clinical follow-up ( follow-up mean 20.5 months , median 18.3 months , range 6.2–60 months ) . Conclusion 11C-Choline PET/CT had a significant impact on therapeutic management in rPCa patients . It led to an overall change in 46.7 % of patients , with a major clinical change implemented in 18 % of patients . Further prospect i ve studies are needed to evaluate the effect of such treatment changes on patient survival In prostate cancer with biochemical failure after therapy , current imaging techniques have a low detection rate at the prostate-specific antigen ( PSA ) levels at which targeted salvage therapy is effective . 11C-choline and 18F-fluoromethylcholine , though widely used , have poor sensitivity at low PSA levels . 68Ga-PSMA ( Glu-NH-CO-NH-Lys-(Ahx)-[68Ga-N , N′-bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylenediamine-N , N′-diacetic acid ] ) has shown promising results in retrospective trials . Our aim was to prospect ively compare the detection rates of 68Ga-PSMA versus 18F-fluoromethylcholine PET/CT in men who were initially managed with radical prostatectomy , radiation treatment , or both and were being considered for targeted therapy . Methods : A sample of men with a rising PSA level after treatment , eligible for targeted treatment , was prospect ively included . Patients on systemic treatment were excluded .  68Ga-PSMA , 18F-fluoromethylcholine PET/CT , and diagnostic CT were performed sequentially on all patients between January and April 2015 , and the images were assessed by masked , experienced interpreters . The findings and their impact on management were documented , together with the results of histologic follow-up when feasible . Results : In total , 38 patients were enrolled . Of these , 34 ( 89 % ) had undergone radical prostatectomy and 4 ( 11 % ) had undergone radiation treatment . Twelve ( 32 % ) had undergone salvage radiation treatment after primary radical prostatectomy . The mean PSA level was 1.74 ± 2.54 ng/mL. The scan results were positive in 26 patients ( 68 % ) and negative with both tracers in 12 patients ( 32 % ) . Of the 26 positive scans , 14 ( 54 % ) were positive with 68Ga-PSMA alone , 11 ( 42 % ) with both 18F-fluoromethylcholine and 68Ga-PSMA , and only 1 ( 4 % ) with 18F-fluoromethylcholine alone . When PSA was below 0.5 ng/mL , the detection rate was 50 % for 68Ga-PSMA versus 12.5 % for 18F-fluoromethylcholine . When PSA was 0.5–2.0 ng/mL , the detection rate was 69 % for 68Ga-PSMA versus 31 % for 18F-fluoromethylcholine , and when PSA was above 2.0 , the detection rate was 86 % for 68Ga-PSMA versus 57 % for 18F-fluoromethylcholine . On lesion-based analysis , 68Ga-PSMA detected more lesions than 18F-fluoromethylcholine ( 59 vs. 29 , P < 0.001 ) . The tumor-to- background ratio in positive scans was higher for 68Ga-PSMA than for 18F-fluoromethylcholine ( 28.6 for 68Ga-PSMA vs. 9.4 for 18F-fluoromethylcholine , P < 0.001 ) . There was a 63 % ( 24/38 patients ) management impact , with 54 % ( 13/24 patients ) being due to 68Ga-PSMA imaging alone . Histologic follow-up was available for 9 of 38 patients ( 24 % ) , and 9 of 9 68Ga-PSMA – positive lesions were consistent with prostate cancer ( 68Ga-PSMA was true-positive ) . The lesion positive on 18F-fluoromethylcholine imaging and negative on 68Ga-PSMA imaging was shown at biopsy to be a false-positive 18F-fluoromethylcholine finding ( 68Ga-PSMA was true-negative ) . Conclusion : In patients with biochemical failure and a low PSA level , 68Ga-PSMA demonstrated a significantly higher detection rate than 18F-fluoromethylcholine and a high overall impact on management This prospect i ve pilot study evaluated the ability of Na18F PET/CT to detect and monitor bone metastases over time and its correlation with clinical outcomes and survival in advanced prostate cancer . Methods : Sixty prostate cancer patients , including 30 with and 30 without known bone metastases by conventional imaging , underwent Na18F PET/CT at baseline , 6 mo  , and 12 mo . Positive lesions were verified on follow-up scans . Changes in SUVs and lesion number were correlated with prostate-specific antigen change , clinical impression , and overall survival . Results : Significant associations included the following : SUV and prostate-specific antigen percentage change at 6 mo ( P = 0.014 ) and 12 mo ( P = 0.0005 ) ; SUV maximal percentage change from baseline and clinical impression at 6 mo ( P = 0.0147 ) and 6–12 mo ( P = 0.0053 ) ; SUV change at 6 mo and overall survival ( P = 0.018 ) ; number of lesions on Na18F PET/CT and clinical impression at baseline ( P < 0.0001 ) , 6 mo ( P = 0.0078 ) , and 12 mo ( P = 0.0029 ) ; and number of lesions on Na18F PET/CT per patient at baseline and overall survival ( P = 0.017 ) . In an exploratory analysis , paired 99mTc-methylene diphosphonate bone scans ( 99mTc-BS ) were available for 35 patients at baseline , 19 at 6 mo , and 14 at 12 mo ( 68 scans ) . Malignant lesions on Na18F PET/CT ( n = 57 ) were classified on 99mTc-BS as malignant 65 % of the time , indeterminate 25 % of the time , and negative 10 % of the time . Additionally , 69 % of paired scans showed more lesions on Na18F PET/CT than on 99mTc-BS . Conclusion : The baseline number of malignant lesions and changes in SUV on follow-up Na18F PET/CT significantly correlate with clinical impression and overall survival . Na18F PET/CT detects more bone metastases earlier than 99mTc-BS and enhances detection of new bone disease in high-risk patients 
    Output:
    
Conclusions According to the meta- analysis , PSMA-PET/CT had the highest per-patient sensitivity and specificity in detecting bone metastases with prostate cancer .
The sensitivities of NaF-PET/CT and MRI were better than those for choline-PET/CT and BS .
The specificity of PSMA-PET/CT was significantly better than BS .
Others were similar .
For per-lesion , NaF-PET/CT had the highest sensitivity , PSMA-PET/CT had higher sensitivity than choline-PET/CT and MRI , and BS had the lowest sensitivity