Influence of Local Tumour Stage and Grade on Reliability of Serum Prostate-Specific Antigen in Predicting Skeletal Metastases in Patients with Adenocarcinoma of the Prostate

Bruwer, G. E.; Cf, Heyns; Allen, F. J.

doi:10.1159/000019850

Cited by 34 publications

(24 citation statements)

References 14 publications

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“…However, none of the previously published studies have included sufficient numbers of subjects to differentiate the risk of metastases above PSA values of 100 ng/ml. We found that only 59% of 3527 men with between 100 and 300 ng/ml had distant metastases on standard imaging.We are not aware of any previous studies that have assessed the survival in men with PSA values above 100 ng/ml and no distant metastases.The probability of a positive imaging examination in men with PSA ≥100 ng/ml at diagnosis was considerably lower in the present study than reported previously 3,[6][7][8]13 .This likely reflects an influence of stage migration with lower PSA values within all risk categories, in contemporary than in historic cohorts.Strengths of the present study included the large study population and the use of data retrieved from nationwide, population based registers that ensured strong external validity. Nearly all men in Sweden diagnosed with prostate cancer are captured in the NPCR.…”

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confidence: 74%

The Risk of Distant Metastases and Cancer Specific Survival in Men with Serum Prostate Specific Antigen Values above 100 ng/ml

et al. 2015

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confidence: 74%

The Risk of Distant Metastases and Cancer Specific Survival in Men with Serum Prostate Specific Antigen Values above 100 ng/ml

et al. 2015

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“…Indeed, studies showed that PSA has predictive value for PCa bone metastases. PSA levels exceeding 100 ng/mL are associated with a 41.4–79.9% probability of bone metastasis, while the probability is low at PSA concentrations lower than 20 ng/L [30,31]. In this study, the mean PSA concentration for PCa patients with bone metastasis was significantly higher than that in the group of patients without metastasis.…”

Section: Discussionmentioning

confidence: 63%

Associations of Prostate-Specific Antigen, Prostate Carcinoma Tissue Gleason Score, and Androgen Receptor Expression with Bone Metastasis in Patients with Prostate Carcinoma

et al. 2017

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BackgroundProstate carcinoma (PCa) is often not diagnosed until advanced disease with bone metastasis. Predictive factors for bone metastasis are required to improve patient outcomes. The study aimed to analyze the factors associated with bone metastases in newly diagnosed patients with PCa.Material/MethodsThis was a retrospective study of 80 patients newly diagnosed with PCa by pathological examination between January 2012 and December 2014. Bone metastases were diagnosed by positron emission computed tomography. Clinical data, serological laboratory results, and pathological examination results were collected.ResultsAmong the 80 patients, 45 (56%) had bone metastases. Age, serum alkaline phosphatase, prostate-specific antigen (PSA), erythrocyte sedimentation rate, PCa tissue Gleason score, androgen receptor (AR) expression, and Ki-67 expression were higher in patients with bone metastasis compared with those without (all P<0.05). Multivariate logistic regression showed that PSA (OR: 1.005; 95%CI: 1.001–1.010; P=0.016), Gleason score (OR: 4.095; 95%CI: 1.592–10.529; P=0.003), and AR expression (OR: 14.023; 95%CI: 3.531–55.6981; P=0.005) were independently associated with bone metastases. Cut-off values for PSA, Gleason score, and AR expression were 67.1 ng/ml (sensitivity: 55.6%; specificity: 97.1%), 7.5 (sensitivity: 75.6%; specificity: 82.9%), and 2.5 (sensitivity: 84.0%; specificity: 91.4%), respectively.ConclusionsPSA, Gleason score, and AR expression in PCa tissues were independently associated with PCa bone metastases. These results could help identifying patients with PCa at high risk of bone metastases.

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“…Gleason grade, although used commonly in staging algorithms as a predictor of capsular penetration, seminal vesicle invasion, and lymph node metastases [10,14,15], has not been utilized to the same extent for predicting bone metastases [16,17]. Few investigators have observed positive correlation between histopathological grade and metastases on bone scan [9,18]. However, the disease stage was not representative of the stage migration currently seen in our prostate cancer population.…”

Section: Discussionmentioning

confidence: 94%

The Utilization of Gleason Grade as the Primary Criterion for Ordering Nuclear Bone Scan in Newly Diagnosed Prostate Cancer Patients

Ritenour

Abbott

Goodman

et al. 2009

The Scientific World JOURNAL

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Utilization of nuclear bone scans for staging newly diagnosed prostate cancer has decreased dramatically due to PSA-driven stage migration. The current criteria for performing bone scans are based on limited historical data. This study evaluates serum PSA and Gleason grade in predicting positive scans in a contemporary large series of newly diagnosed prostate cancer patients. Eight hundred consecutive cases of newly diagnosed prostate cancer over a 64-month period underwent a staging nuclear scan. All subjects had histologically confirmed cancer. The relationship between PSA, Gleason grade, and bone scan was examined by calculating series of crude, stratified, and adjusted odds ratios with corresponding 95% confidence intervals. Four percent (32/800) of all bone scans were positive. This proportion was significantly lower in patients with Gleason score ≤7 (1.9%) vs. Gleason score ≥8 (18.8%, p < 0.001). Among patients with Gleason score ≤7, the rate of positive bones scans was 70-fold higher when the PSA was >30 ng/ml compared to ≤30 ng/ml (p < 0.001). For Gleason score ≥8, the rate was significantly higher (27.9 vs. 0%) when PSA was >10 ng/ml compared to ≤10 ng/ml (p = 0.002). The combination of Gleason score and PSA enhances predictability of bone scans in newly diagnosed prostate cancer patients. The PSA threshold for ordering bone scans should be adjusted according to Gleason score. For patients with Gleason scores ≤7, we recommend a bone scan if the PSA is >30 ng/ml. However, for patients with a high Gleason score (8-10), we recommend a bone scan if the PSA is >10 ng/ml. KEYWORDS: prostate, prostatic neoplasm, bone scan, staging, Gleason grade, prostatespecific antigen Ritenour et al.: Gleason Grade and Bone Scans TheScientificWorldJOURNAL (2009) 9, 1040-1045 1041 INTRODUCTIONProstate cancer is the most common internal cancer and the second leading cause of cancer death in American men. The American Cancer Society estimates that approximately 186,320 new cases of prostate cancer were diagnosed in 2008 in the U.S. and 28,660 men died of the disease. Current recommendations of annual screening with the prostate specific antigen test (PSA) and digital rectal examination (DRE) have led to a stage migration with a shift toward clinically localized disease [1]. Ninety percent of all prostate cancers are discovered in the local and regional stages with a 5-year survival approaching 100% [2]. The relative 10-and 15-year survival is 91 and 76%, respectively. Recommendation of the appropriate treatment plan requires accurate staging of the disease. At this time, there is no formal consensus on the pretreatment staging for prostate cancer [3,4].Nuclear bone scan is the current gold standard for staging bone metastases compared to plain skeletal radiography or serum alkaline phosphatase and acid phosphatase levels [5,6]. Until a decade ago, bone scans were routinely performed on newly diagnosed prostate cancer patients [3]. With the introduction of PSA testing, such nondiscriminatory use of bone scans was reduced. Va...

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Influence of Local Tumour Stage and Grade on Reliability of Serum Prostate-Specific Antigen in Predicting Skeletal Metastases in Patients with Adenocarcinoma of the Prostate

Cited by 34 publications

References 14 publications

The Risk of Distant Metastases and Cancer Specific Survival in Men with Serum Prostate Specific Antigen Values above 100 ng/ml

The Risk of Distant Metastases and Cancer Specific Survival in Men with Serum Prostate Specific Antigen Values above 100 ng/ml

Associations of Prostate-Specific Antigen, Prostate Carcinoma Tissue Gleason Score, and Androgen Receptor Expression with Bone Metastasis in Patients with Prostate Carcinoma

The Utilization of Gleason Grade as the Primary Criterion for Ordering Nuclear Bone Scan in Newly Diagnosed Prostate Cancer Patients

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