***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: BACKGROUND Multiparametric magnetic resonance imaging ( mpMRI ) is the st and ard for local prostate cancer ( PCa ) staging . Whole-body MRI ( wbMRI ) has shown capabilities for metastatic screening . This study assesses the feasibility and value of an all-in-one AJCC TNM staging of PCa during a unique MRI session combining mpMRI and wbMRI . METHODS Thirty consecutive patients with " high-risk " PCa prospect ively underwent  mpMRI of the prostate and wbMRI , in addition to ( 99 m ) Tc bone scan ( BS ) , completed with st and ard X-rays ( ±TXR ) and contrast enhanced CT for distant staging . For the statistical analysis , a " best valuable comparator " ( BVC ) combining a panel review of all available baseline and follow-up imaging , biological , and clinical data was used to adjudicate lymph node and bone metastatic status . RESULTS Prostate mpMRI was analyzed using ESUR guidelines . Sensitivity of BS ± TXR combined with CT and of wbMRI for detecting metastases ( bones or nodes ) was 85 % and 100 % , respectively , and specificity was 88 % and 100 % , respectively . For the overall staging of the patients as being either N0M0 or having disease extension beyond the prostate , wbMRI was superior to the combination of BS and CT ( improvement in all ROC characteristics and of AUC by 13.6 % ( 95 % CI : + 0.7 % to + 26.5 % , P = 0.039 ) ) . The main limitation is the limited number of patients . CONCLUSIONS AJCC M and N staging using wbMRI is feasible during the same imaging session as mpMRI performed for T staging , in less then one hour . wbMRI  outperforms BS ± TXR and abdomino-pelvic CT work up for discriminating subsets of patients with or without distant spread of the cancer Purpose This study was design ed to assess the additional value of SPECT/CT of the trunk used in conjunction with conventional nuclear imaging and its effects on patient management in a large patient series . Methods In 353 patients , whole-body scintigraphy ( WBS ) , SPECT , and SPECT/CT were prospect ively performed for staging and restaging . SPECT/CT of the trunk was performed in all patients . In the 308 evaluable patients ( 211 with breast cancer , 97 with prostate cancer ) , clinical follow-up was used as the gold st and ard . Bone metastases were confirmed in 72 patients and excluded in 236 . Multistep analyses per lesion and per patient were performed . Clinical relevance was expressed in terms of downstaging and upstaging rates on a per-patient basis . Results In the total patient group , sensitivities , specificities , and negative and positive predictive values on a per-patient basis were 93 % , 78 % , 95 % and 59 % for WBS , 94 % , 71 % , 97 % and 53 % for SPECT , and 97 % , 94 % , 97 % and 88 % for SPECT/CT , respectively . In all subgroups , specificity and positive predictive value were significantly ( p < 0.01 ) better with SPECT/CT .  Downstaging of metastatic disease in the total , breast cancer and prostate cancer groups using SPECT/CT was possible in 32.1 % , 33.8 % and 29.5 % of patients , respectively . Upstaging in previously negative patients by additional  SPECT/CT  was observed in three breast cancer patients ( 2.1 % ) . Further diagnostic imaging procedures for unclear scintigraphic findings were necessary in only 2.5 % of patients . SPECT/CT improved diagnostic accuracy for defining the extent of multifocal metastatic disease in 34.6 % of these patients . Conclusions SPECT/CT significantly improved the specificity and positive predictive value of bone scintigraphy in cancer patients . In breast cancer patients , we found a slight increase in sensitivity .  SPECT/CT had a significant effect on clinical management because of correct downstaging and upstaging , better definition of the extent of metastases , and a reduction in further diagnostic procedures 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 OBJECTIVES The aim of this study was to correlate the prostate-specific antigen ( PSA ) level and Gleason score with staging bone scan result in patients with a new diagnosis of prostate cancer in order to establish the feasibility of implementing the European Association Urology guidelines , which state that a bone scan may not be indicated when PSA < 20 in well-moderately differentiated tumours . METHODS We identified 633 patients retrospectively and 186 patients prospect ively with a new diagnosis of prostate cancer undergoing a staging bone scan between March 2005 and January 2010 . Patients were excluded if there was no Gleason score available or if the PSA level was checked over 3 months prior to bone scan .  Bone scan results were analysed with respect to age , PSA level and Gleason score . In the case of an equivocal result , subsequent imaging was taken into consideration or the initial bone scan was re- review ed . In persistently equivocal cases , all relevant imaging was assessed by a blinded panel of radiologists to allow a final decision to be made . RESULTS Of 672 patients aged 39 - 93 years ( median 71 years ) , who fulfilled the inclusion criteria , 54 ( 8 % ) had evidence of bony metastases . PSA level and Gleason score were both independent predictors of bone scan positivity and their predictive value was additive p<0.01 . None of the 357 patients with a PSA level of < 20 and a Gleason score of < 8 had a positive bone scan .  CONCLUSION Staging bone scans in newly diagnosed prostate cancer patients with a PSA level of < 20 and a Gleason score of < 8 can be safely omitted , with these criteria having a negative predictive value of 100 % in our series Background International guidelines uniformly suggest no routine staging of bone metastasis in patients with bone scintigraphy ( BS ) in low-risk prostate cancer ( PCa ) . These recommendations are based on retrospective investigations only . In addition , BS has most often been reported as a definitive investigation with no room for equivocal cases . Objective The objective of this study was to determine the diagnostic value of BS in a large cohort of consecutive patients with newly diagnosed PCa . Design , Setting , and Participants Over a period of 1.5 years in 2008 to 2009 , consecutive patients with newly diagnosed PCa were enrolled in a noninterventional , multicenter , observational study . All patients had a whole-body , planar BS .  Clinical history and clinical , pathological , and biochemical data were obtained from electronic patient files and question naires . Outcome Measurements and Statistical Analysis Bone scintigraphy was classified into 4 categories as nonmalignant , equivocal , likely malignant , or multiple metastasis . The primary end point was final imaging , which was a composite end point of BS and additional CT and MRI investigations . Results and Limitations A total of 635 eligible patients were recruited . Their median prostate-specific antigen ( PSA ) was 15 ng/mL , median Gleason was 7 , and 80 % of patients had local disease ( T1 or T2 ) . The proportion of nonmalignant BS was 61 % , equivocal scans 26 % , and likely or definitive metastasis 13 % . A total of 154 patients had additional CT or MRI investigations . The final imaging diagnosis showed a prevalence of bone metastases in 87 ( 13.7 % ) of 635 patients . No bone metastases were observed in ( 1 ) patients with PSA of less than 10 ng/mL , independently of the clinical Tstage and Gleason score ( n = 212 ) and ( 2 ) PSA of less than 20 ng/mL if Tstage is less than T3 and Gleason score is less than 8 ( n = 97 ) . Approximately 50 % of the patients enrolled in this study met these criteria . Conclusion This is the first prospect i ve trial to demonstrate that BS can be avoided in patients with low-risk PCa Background The majority of enhancing renal masses are unable to be effectively characterized as benign or malignant using st and ard cross-sectional imaging modalities including multi-phase computed tomography ( CT ) [ 1 ] and magnetic resonance imaging ( MRI ) [ 2 ] . This is particularly unfortunate in light of the steady increase in the incidence of these lesions , many of which are discovered incidentally on imaging studies performed for nonurologic indications [ 3 , 4 ] . Moreover , it has been estimated that upwards of 5600 unnecessary partial and radical nephrectomies are performed each year in the USA for the false presumption of cancer [ 5 ] . In light of these data , recently , there has been a growing interest in the use of molecular imaging to characterize the aggressiveness of renal masses [ 6 , 7 ] . To date , several reports have been published on the ability of Tc-sestamibi planar and single photon emission computed tomography (SPECT)/CT imaging to differentiate mitochondrial-rich benign and indolent renal masses such as oncocytomas and hybrid oncocytic/ chromophobe tumors ( HOCTs ) from more aggressive renal tumor histologies including the clear cell subtype of renal cell carcinoma ( RCC ) [ 8–10 ] . In this issue of European Journal of Nuclear Medicine and Molecular Imaging Research , Tzortzakakis et al. [ 11 ] add to this body of literature with a prospect i ve study evaluating Tc-sestamibi SPECT/CT in 24 patients with 31 clinical ly localized T1 renal masses planned for biopsy or surgery . The authors reported that 11 of 12 ( 92 % ) oncocytomas and 3 of 3 ( 100 % ) HOCTs demonstrated Tc-sestamibi uptake , while all other lesions were negative for uptake with the exception of mild uptake in a single papillary RCC . These findings are concordant with earlier studies [ 9 , 10 ] and dramatically increase the number of Tc-sestamibi positive oncocytomas and HOCTs reported in the literature . As a brief aside , it should be mentioned that there is also a growing interest in the use of renal mass biopsy for determining the histology of renal tumors , particularly as data from two recent systematic review s have suggested that the rates of complications and nondiagnostic biopsies are tolerable [ 12 , 13 ] . However , limitations of renal mass biopsy remain , including the intrinsically invasive nature of this procedure , the inaccessibility of some tumors to safe approaches for biopsy , and the heterogeneous population of renal masses that can present as oncocytic neoplasms on biopsy [ 14 , 15 ] . As such , the non-invasive characterization of renal masses with molecular imaging techniques continues to be of interest and may serve as an adjunct to , or even a replacement of , biopsy in selected cases Presently , the st and ard staging evaluation of prostate cancer includes digital rectal examination , measurement of serum tumor markers and a radionuclide bone scan . To evaluate the ability of local clinical stage , tumor grade , serum acid phosphatase , serum prostatic acid phosphatase ( PAP ) and serum pro 
    Output:
    
Indeterminate bone scan for staging of prostate cancer was insufficiently reported in clinical trials .
In the case of indeterminate scans , most studies provided adequate measures to obtain the final status of the patients