Application of bone scans for prostate cancer staging: Which guideline shows better result?

Chong, Ari; Hwang, In-Sun; Ha, Jung‐Min; Yu, Seong Hyeon; Hwang, Eu Chang; Yu, Ho Song; Kim, Sun Ouck; Jung, Sang-Don; Kang, Taek Won; Kwon, Dong Deuk; Park, Kwangsung

doi:10.5489/cuaj.2054

Cited by 9 publications

(33 citation statements)

References 18 publications

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“…However, values between 10 and 20 remain in the gray zone. 8 NICE guidelines (updated on December 15, 2021) added another group of patients to whom an isotope bone scan should not be routinely offered. Namely Cambridge prognostic group 2.…”

Section: Discussionmentioning

confidence: 99%

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Safely omitting bone isotope scans in a cohort of grade group 2 prostate cancer

Mustaffa

Emara

2022

The Prostate

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Objective A retrospective review conducted in our urology unit to assess the efficiency for requesting bone scans for newly diagnosed prostate cancer patients, aiming to minimize radiation exposure and avoiding unnecessary investigations as cost effective measure. Methods A retrospective observational study included 360 patients with newly diagnosed prostate cancer within urology department at Calderdale and Huddersfield NHS Trust from April 2016 to March 2018. Parameters observed were: the prostatic specific antigen (PSA) on diagnosis, Gleason score, staging magnetic resonance imaging, and bone scans. We analyzed the possible correlation of the Gleason score and PSA to determine the risk of bony metastasis. Regarding PSA: Patients were categorized as with PSA <15, PSA ≥15. Regarding Gleason score: Patients were categorized as patients with grade group 1 or 2 and patients with grade group 3 and above. Data recorded was then analyzed using χ2 analysis to determine if results were deemed significant or not. Results A total of 360 patients: 91 patients (25%) had positive bony metastasis. While 269 patients (75%) had a clear bone scan. Among patients with grade group 3 or above or having PSA ≥15, 90 patients out of 324 patients had bony metastasis (38%). Among patients with grade group 1 or 2 and PSA <15, only 1 patient out of 36 had bony metastasis (2.7%). Negative predictive value of grade group 1 or 2 and PSA <15 for bony metastasis was 97.22%. Conclusion Using a cutoff level of PSA <15 in grade group 1 and 2 seems to be a safe and efficient tool to exclude newly diagnosed prostate cancer patients from having an isotope bone scan for staging purpose.

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Section: Discussionmentioning

confidence: 99%

“…Also there is no debate about PSAs less than 10 or more than 20. However, values between 10 and 20 remain in the gray zone 8 …”

Section: Discussionmentioning

confidence: 99%

Safely omitting bone isotope scans in a cohort of grade group 2 prostate cancer

Mustaffa

Emara

2022

The Prostate

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“…The risk profile in our study included low-, intermediate-, and high-risk patients. Although the use of 99m Tc-PSMA is mostly reserved for detection of occult disease in patients with low PSA 41 , 42 and primary staging of high-risk patients 43 , 44 and bone scan to intermediate- to high-risk patients, 12 we were also interested in seeing how 99m Tc-PSMA performs in patients across the risk spectrum, including patients typically reserved for staging bone scan. 6 Thomsen et al 45 reported a correlation between advanced disease stage and high PSA with bone metastases, and we report similar findings with patients having advanced disease stage and a high PSA more likely to have metastases on both 99m Tc-PSMA and 99m Tc-MDP scans and with the 2 methods having no statistically significant difference in detection rate (Table 3 ).…”

Section: Discussionmentioning

confidence: 99%

Comparing 99mTc-PSMA to 99mTc-MDP in Prostate Cancer Staging of the Skeletal System

et al. 2021

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Purpose This prospective study was aimed at assessing the ability of 99m Tc-PSMA scan to detect bone metastases in prostate cancer (PCa) against 99m Tc-MDP scan as a standard and assess the correlation of these modalities in PCa staging of bone involvement. Patients and Methods Forty-one patients (41) with histologically confirmed PCa were scanned using both methods. Planar imaging was performed with additional regional SPECT/CT 3 to 4 hours posttracer injection. Scans were reported as positive, negative, or equivocal. In the case of positive scans, lesions were quantified by each of the 3 reporters separately. Planar and SPECT/CT images were reported together to obtain the final report on each scan. Results Our preliminary results showed no significant difference in the detection of bone metastases between the 2 scans. 99m Tc-PSMA detected 52 of the 55 bone lesions detected on 99m Tc-MDP. However, 99m Tc-PSMA provided extra information by reporting lymph nodal metastases in 7 patients and residual disease in the prostate in 2 patients with biochemical progression after radical therapy. In 1 patient, the PSMA scan resulted in change in management with patient now on 177 Lu-PSMA radioligand therapy. Equivocal findings were reported in 4 patients on 99m Tc-MDP and none on 99m Tc-PSMA. Conclusions 99m Tc-PSMA was comparable to 99m Tc-MDP in detection of bone metastases and demonstrated an additional benefit of providing information on visceral disease. 99m Tc-PSMA may be a better alternative to 99m Tc-MDP in staging, restaging, and assessment of patients with biochemical progression after radical therapy of PCa in a resource-limited setup like ours while also assisting to detect patients eligible for PSMA-labeled radioligand therapy.

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“…No study has evaluated the relationship of bone metastasis in PCa and PNI in biopsy yet. In almost all PCa guidelines, bone scan is indicated for the evaluation of skeletal metastasis . Prediction of bone metastasis is also generally based on tPSA level, GS and stage of the disease in almost all of the PCa guidelines.…”

Section: Discussionmentioning

confidence: 99%