A Study on Staging Bone Scans in Newly Diagnosed Prostate Cancer

Abstract

Objective: This study aimed to evaluate the role of bone scan as a staging investigation in newly diagnosed untreated prostate cancers. Materials and Methods: Bone scan results in patients with newly diagnosed prostate cancer were reviewed and correlated with clinical stage, prostate-specific antigen (PSA) and Gleason scores from the biopsy specimen. Results: In all, 124 patients fulfilled inclusion criteria with an age range of 51–94 (mean 72.3) years. Pre-biopsy PSA ranged from 2.2 to 5,864 with a median of 21.1 ng/ml. Clinical stage was T0-T1c 14.5%, T2a 41.9%, T2b 17.7%, T3 16.9%, and T4 9%. A Gleason score of 7 was found in 31%. Four patients’ samples were not suitable for Gleason scoring. Twenty patients (16.1%) had a positive bone scan with a mean age of 79.4 years (median 83). Two patients with PSA <20 ng/ml were positive. Of the 44 scans performed in the patients with PSA ≤20 ng/ml, clinical stage <T4 and Gleason sum ≤7 (with the major Gleason <4), none was positive. The above criteria give a 100% negative predictive value for avoiding bone scans as a staging investigation. Conclusions: Staging bone scan can be safely omitted in patients with a clinical stage of <T4, PSA level of ≤20 ng/ml and a Gleason score of ≤7 (with major Gleason pattern <4) unless the symptoms are suggestive of metastasis.

Changing the referral criteria for bone scan in newly diagnosed prostate cancer patients

“…Like O'Sullivan et al [12] and Ayyathurai et al [13], but at variance with others [2, 3, 10, 11], we found that PSA level and pathological grade had a higher predictive value in combination. Our overall rate of bony metastases differs from that of a large contemporary study by Briganti et al [14]: 8% vs 2.8%.…”

“…Unlike O'Sullivan et al [12] and Ayyathurai et al [13], major Gleason Grade 4 vs 3 made no difference to the rate of bone scan positivity with PSA levels ,20.…”

“…Prostate-specific antigen (PSA) level is an established prognostic marker that correlates with bone scan positivity, and various studies demonstrate a low risk of a positive bone scan in newly diagnosed patients with a low PSA level [3,4,[7][8][9][10][11][12][13]. Gleason score is also of important prognostic significance and has been shown to be an independent predictor of bone scan results on multivariate analysis [4,7,12,14].…”

Establishing the pathways and indications for performing isotope bone scans in newly diagnosed intermediate‐risk localised prostate cancer – results from a large contemporaneous cohort

“…A brief mention is made in the RCR guidelines about the importance of primary pattern 4, but it was within the confines of a high‐risk cancer . A conclusion for not doing a BS when the PSA level is <20 ng/mL with Gleason score <8 with cT stage <4, was reached in two UK‐based studies, unless the primary Gleason pattern is 4 . These two studies suggest that PSA level and Gleason score are independent risk factors for BS positivity.…”

Η Μετεγχειρητική Εξέλιξη Του Καρκίνου Του Προστάτη Μετά Από Ριζική Προστατεκτομή

“…Η μέτρηση της σε συνδυασμό με το PSA αυξάνουν τη διαγνωστική ακρίβεια στο 98% [370]. Παρόλα αυτά, το σπινθηρογράφημα οστών παραμένει η πιο ευαίσθητη μέθοδος αποκάλυψης των οστικών μεταστάσεων και αποτελεί τη μέθοδο εκλογής όταν το PSA είναι μεγαλύτερο από 20 ng/ml [371][372][373][374]. Τέλος, για τη διαπίστωση μεταστάσεων σε άλλα συμπαγή όργανα, η αξονική και η μαγνητική τομογραφία, το υπερηχογράφημα κοιλίας και η κλινική εξέταση αποτελούν τις μεθόδους εκλογής [375].…”