Toward Better Use of Bone Scans Among Men With Early-stage Prostate Cancer

Abstract

Objective To evaluate the performance of published guidelines compared to current practice for radiographic staging of men with newly-diagnosed prostate cancer. Materials and Methods Using data from the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry, we identified 1,509 men diagnosed with prostate cancer from March 2012 through June 2013. Clinical data included age, prostate-specific antigen (PSA), Gleason score (GS), clinical T-stage, number of biopsy cores and bone scan (BS) results. We then fit a multivariable logistic regression model to examine the association between clinical variables and the occurrence of bone metastases. Because some patients did not undergo BS, we used established methods to correct for verification bias and estimate the diagnostic accuracy of published guidelines. Results Among 416 men who received a BS, 48 (11.5%) had evidence of bone metastases. Patients with bone metastases were older, with higher PSA and GS (all p <0.05). In multivariable analyses, PSA (p <0.001) and GS (p =0.004) were the only independent predictors of positive BS. Guidelines from the American Urology Association (AUA) and the National Comprehensive Cancer Network (NCCN) demonstrated similar performance in detecting bone metastases in our population, with fewer negative studies than the European Association of Urology (EAU) guideline. Applying the AUA recommendations (i.e., image when PSA >20 or GS ≥8) to current clinical practice, we estimate that <1% of positive studies would be missed, while the number of negative studies would be reduced by 38%. Conclusions Based on current practice patterns, more uniform application of existing guidelines would ensure that BS is performed for almost all men with bone metastases, while avoiding many negative imaging studies.

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

“…Further external validation study of that CART model showed it to have higher specificity and positive predictive value compared to the EAU guideline, while the sensitivity and the NPV of the CART model was comparable with the EAU guideline . In a similar comparative study by Merdan et al , the AUA and NCCN guidelines were found to be relatively similar to the CART model, concluding that adhering to BS in patients with PSA levels of >20 ng/mL and Gleason >7, will yield fewer negative study results, and fewer BS overall. However, in cancer staging tests the primary goal should be to improve sensitivity without ideally sacrificing specificity and therefore, the comparative models also point toward the superiority of the EAU guidelines.…”

Cost‐effectiveness of magnetic resonance imaging and targeted fusion biopsy for early detection of prostate cancer

“…Patients with PSA concentration >20 ng/mL or a Gleason score ≥8 received a bone scan and a CT scan for staging . Patients with a biopsy result of Gleason score ≥7 underwent radical prostatectomy.…”

ACR Appropriateness Criteria ® Prostate Cancer—Pretreatment Detection, Surveillance, and Staging

“…Bone scan. NCCN guidelines and existing literature [28,87] recommend bone scintigraphy if baseline PSA is 20, clinical stage is T2 and PSA is 10, clinical stage is T3 or T4, Gleason score is 8, or any symptoms are suggestive of bone metastases. Essentially all high-risk patients would meet these criteria.…”