Comparative value of bone scintigraphy and radiography in monitoring tumor response in systemically treated prostatic carcinoma.

Abstract

Radionuclide bone scans and skeletal radiographs were obtained before and during combination chemotherapy or initial hormonal treatment in 46 patients with disseminated adenocarcinoma of the prostate. The purpose of the study was to determine the usefulness of these two modalities in evaluating tumor response to therapy. Prior to treatment, bone scans were positive in 44 patients (96%). In all but one patient either bone radiographs or bone marrow biopsy revealed evidence of osseous metastases. In 22 patients partial response to therapy was documented by a variety of other staging tests. Eleven of these patients showed concurrent or later improvement on bone scans; one showed improvement on a radiograph. "Flare phenomena" were observed relatively frequently since 23% of the scans and 50% of the radiographs showed worsening at the time of response. Bone scans revealed worsening in 79% of 33 patients with disease progression of extraosseous tumor; radiographs were equally sensitive (82% worsening). It is concluded that bone scans in particular are useful for monitoring tumor status in systemically treated patients with prostate cancer. However, because of the lack of sensitivity for response and paradoxical worsening with tumor regression in some patients, scans are not accurate enough to be employed as the sole test in following these patients.

Weekly chemotherapy in advanced prostatic cancer

“…Currently, the most widely used response criteria are those of National Prostatic Cancer Project (NPCP) (Slack & Murphy, 1984), but these criteria are insufficient for monitoring the turnover of osteoblastic bone metastases. In fact, radiographic resolution of osteoblastic lesions is rare, while the detection of scintigraphic changes requires careful attention to technical details of scanning (Levenson et al, 1983 Patients were considered evaluable for response and toxicity only after they had undergone at least six courses of chemotherapy.…”

The value of thallium and three-phase bone scans in the evaluation of bone and soft tissue sarcomas

“…Patient evaluation for new or recurrent sarcomas is currently done by clinical evaluation, diagnostic radiology procedure (computed tomography, magnetic resonance imaging, angiography), biochemical markers, radionuclide scans, and histological examination. The delayed bone scan is the most frequently used radionuclide procedure for evaluation of primary and metastatic bone tumors [28][29][30]. It has a high sensitivity for bone sarcomas and metastatic bone disease.…”

Co-existent Paget’s Disease of the Bone, Prostate Carcinoma Skeletal Metastases and Fracture on Skeletal Scintigraphy-Lessons to be Learned

“…There is usually no bony deformity or overgrowth. Plain radiography is extremely useful in this situation and frequently resolves the problem (7). …”