Which patients with prostatic carcinoma require a staging bone scan

Abstract

ObjectiveTo determine whether the level of prostateshowing bony metastases had a PSA level >40 ng/mL. Reviewing the other published studies specific antigen (PSA) can be used to decide which patients with newly diagnosed prostatic carcinoma showed that in those newly diagnosed patients with a PSA level of <20 ng/mL, the probability of having require a staging bone scan. Patients and methods Of patients referred during an bony metastases detected on a bone scan was <1%. Conclusions A staging bone scan can be omitted in the 18-month period for a staging bone scan, 98 (median age 72 years, range 52-89) had had their serum PSA vast majority of patients with newly diagnosed prostatic carcinoma and a PSA level <20 ng/mL. level determined within 4 weeks of the bone scan and were assessed retrospectively for the presence of bony Keywords Prostatic neoplasms, prostate-specific antigen, neoplasm staging, radionuclide imaging metastases.Results Of the 98 patients, 26 who had bone scans Introduction Patients and methodsThe notes of all patients referred for a bone scan from Prostatic carcinoma has the second highest cancer mortality in males in the UK. It is responsible for over 10 000 three consultant urologists over an 18 month period were scrutinized. Patients were included if there was (i) deaths and 14 000 new cases diagnosed each year. The difference in incidence and mortality reflect that some histological confirmation of the diagnosis of prostatic carcinoma, (ii) the staging bone scan and PSA level were men will die with, rather than from, prostatic carcinoma.It is common practice in the UK to undertake bone undertaken within 4 weeks of each other, (iii) the bone scan findings were unequivocal or equivocal findings scintigraphy as part of the routine staging procedure in men with newly diagnosed prostatic carcinoma. It has were confirmed by other imaging modalities and (iv) no therapy was initiated (surgery, radiotherapy or hormone been known for over 20 years that bone scintigraphy is more sensitive than whole-body skeletal radiography in manipulation) before the bone scan and PSA determination. detecting bony metastases [1]. However, although common practice, in recent years the necessity of scintigAll whole-body bone scans were carried out in the Department of Nuclear Medicine, Addenbrooke's NHS raphy for all cases has been questioned [2,3].PSA was first isolated in 1979 [4] and is derived from Trust and were acquired on an Elscint Helix APXSPX machine 4 h after an intravenous injection of 550 MBq acinar and ductal epithelial cells of normal, hyperplastic and carcinomatous prostatic tissue [5]. It is found in low of technetium-99 m MDP. Images were interpreted by consultants in Nuclear Medicine. Total PSA measureconcentrations in the serum of healthy men. Given that serum PSA is associated with increasing stage and ments were made in the Department of Biochemistry, Addenbrooke's NHS Trust using a two-site immunovolume of prostate cancer, it may be possible to use this serum marker to determine whether a bone sca...

Predictive value of serum prostate specific antigen in detecting bone metastasis in prostate cancer patients using bone scintigraphy

“…Our results strengthen previous reports in the literature that state that a PSA of ≤ 20 ng/ml is an appropriate cut-off for BS investigation in prostate cancer asymptomatic for bone metastasis. [721] However, careful review of these studies indicate significant differences in the study populations and selection bias and hence PSA threshold cut-off.…”

Saudi oncology society and Saudi urology association combined clinical management guidelines for prostate cancer

“…[23]Bone scan: Should only be done if any of the following (EL-2):[45] Prostate-specific antigen (PSA) level > 20 ng/mL.Patients with bony pain.Gleason score >7.Patient with clinical stage T3 or T4.Hypercalcemia, high serum alkaline phosphatase. STAGING CLASSIFICATIONThe tumor node metastasis staging will be used[6]Primary tumor (T) TX - Tumor cannot be assessedT0 - No evidence of the primary tumorT1 - Clinically neither palpable nor visible by imaging T1a - Found incidental to other surgery; present in 5% or less of tissueT1b - Found incidental to other surgery; present in 5% or more of tissueT1c - Identified by needle biopsy T2 - Tumor confined within prostate T2a - Involving one-half of one lobe or lessT2b - Involving more than one-half of one lobe, but not both lobesT2c - Involving both lobes T3 - Tumor extends through prostate capsule T3a - Extracapsular extension (unilateral or bilateral)T3b - Tumor invades the seminal vesicle (s) T4 - Involves structures other than seminal vesicles T4a - Invades adjacent structure (s) other than seminal vesicles: Bladder, external sphincter, or rectum, lavatory muscle and (or) pelvic side wallsT4b - Invades muscles and/or pelvic wall Regional lymph nodes (N) NX - Nodes cannot be assessedN0 - No regional node metastasisN1 - Metastasis in regional nodes Distant Metastasis (M) M0 - No distant metastasisM1 - Distant metastasisM1a - Nonregional lymph node (s)M1b - Bone (s)M1c - Other site (s) with or without bone disease MANAGEMENT OPTIONSThis will depend on the stage (localized vs. metastatic), the risk group and life expectancy. [7]…”

“…[23]Bone scan: Should only be done if any of the following (EL-2):[45] Prostate-specific antigen (PSA) level > 20 ng/mL.Patients with bony pain.Gleason score >7.Patient with clinical stage T3 or T4.Hypercalcemia, high serum alkaline phosphatase. …”

Prostate Cancer in the Elderly

“…While metastatic spread of prostate cancer is usually confined to the lymph nodes and bone, almost any organ can become involved. Bone scanning and CT scans are commonly used to detect the metastatic spread of prostate cancer [25,26].…”