Bone Scanning Who Needs it Among Patients with Newly Diagnosed Prostate Cancer?

Abstract

For patients with serum PSA levels of 10 ng/ml or lower, bone scanning may be eliminated because of the negligible risk of bone metastases. In addition, scanning may not be necessary for those with PSA levels between 10 and 20 ng/ml, when they have T1 disease and Gleason scores of 6 or lower.

Can PSA Predict Bone Metastasis amongst Newly Diagnosed Prostate Cancer Patients?

“…The Gleason score was an independent predictor of bone metastases with majority of patients with a score of 8-10 (56%, 9 out of 16 patients) having positive bone scans and majority of those with a score of 7 and below (94%, 36 out of 38 patients) having negative bone scans. This was in agreement with other studies done in the United Kingdom (12), Pakistan (13) and Japan (16). One of the limitations of this study is that it was a hospital-based, and had a limited number of patients (patients undergoing bone scans during the study period, 5 months), thus the results obtained are less representative of the true picture in the general Kenyan population, due to the small sample size and patient selection bias.…”

Retrospective Study of Predictors of Bone Metastasis in Prostate Cancer Cases

“…The similar study also suggested that bone scan be omitted in patients with Gleason score of 6 or lower. Besides PSA level less than 10ng/ml, Hirobe et al (2007) also recommended to omit bone scan in patients with PSA level between 10-20ng/ml, when they are T1 disease and having a Gleason score of 6 or lower.…”

“…suggested that bone scan should be done only in selective high risk patients (Oesterling et al, 1993;Lee et al, 2000;Abuzallouf et al, 2004;Hirobe et al, 2007). However, in another study, it has been suggested that bone scan should be used in all patients as there is a lack of reliable marker to identify high risk patients (Wolff et al, 2000).…”

Do all patients with newly diagnosed prostate cancer need staging radionuclide bone scan? a retrospective study

“…This may be translated into a high number of patients where staging bone scan studies can be avoided with a significant reduction of costs for the health care system. The American Urological Association (AUA) (9) and the European Association of Urology (EAU) (10) guidelines for prostate cancer suggest that bone scan may not be indicated in asymptomatic patients if serum PSA level is less than 20 ng/mL in the presence of well differentiated tumor, while the Japanese Urological Association guidelines for prostate cancer in 2006 indicates that a bone scan can be omitted for patients with PSA level of 10 ng/mL or less who have well differentiated prostate cancer (11). Although the issue remains controversial and the AUA and EUA guidelines for prostate cancer are still externally not completely validated, in this study we retrospectively tried to evaluate the relationship between clinical T stage, serum PSA level, Gleason score and bone metastasis, in an attempt to define a group of patients whose risk of a positive radioisotope bone scan is low enough to be omitted.…”