Broadening the criteria for avoiding staging bone scans in prostate cancer: a retrospective study of patients at the Royal Marsden Hospital

O’Sullivan, Joe M.; Norman, A.; Cook, Gary; Fisher, Cyril; Dearnaley, David P.

doi:10.1046/j.1464-410x.2003.04480.x

Cited by 57 publications

(57 citation statements)

References 21 publications

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“…In this regard; when we examined the GS values in our study, they were found as ≤6 in 5 of 29 (17%, 2) patients with bone metastases, as 7 in 8 of the 29 (27.6%) of them, and >8 in 16 of 29 (55.2%). These results suggest that the incidence of bone metastasis is very high in patients with a GS >6 and bone scintigraphy should be performed, and they are compatible with other studies (16,17). On the other hand, when we examine our study which is based on the studies and guidelines suggesting that bone scintigraphy is appropriate for patients with GS≥8, it is understood that 44.9% (13/29) of patients with bone metastasis can be missed out.…”

Section: Discussionsupporting

confidence: 86%

Relationship Between Bone Scintigraphy Results and Gleason Scores and Prostate- Specific Antigen Levels

Şahin¹

2017

Istanbul Med J

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Prostate cancer (PCa) is the most common non-cutaneous cancer in men, especially in the U.S. and European countries, although it is seen at various frequencies depending on genetic and regional differences (1, 2). Because the surgical treatment is the most effective method for localized PCa, accurate staging in patients is very important in terms of treatment and therefore survival morbidity. The most common distant metastasis in PCa is bone metastases, and the majority of them have osteoblastic characteristics, and they can be detected with high accuracy through the whole-body bone scintigraphy with the technetium 99 m-methylene diphosphonate (Tc99m-MDP). Although scintigraphic method has advantages such as high sensitivity and a full body scanning in one step; due to their low specificity and cost disadvantages, there is still no clear consensus in all countries to use it in staging before the treatment in newly diagnosed patients with prostate cancer. If the prostate-specific antigen (PSA) is ≤20 ng/mL, the Gleason score (GS) is ≤7, and the patient has no additional complaint, there is no need for scintigraphic imaging for bone metastasis according to the guidelines of prostate cancer of the American and European Urology associations; however the prostate cancer guideline of the Japanese Urology Association does not accept this view (3-5). While the National Comprehensive Cancer Network (NCNN) recommends bone scintigraphy in clinical T3, T4 stage patients or in patients with bone symptoms, it has the opinion that bone scintigraphy should be performed if the PSA value is above 10 ng/mL or GS value is 8 or above in patients with the stage of T1 or T2 (6). As can be understood from these, it is controversial in which cases bone scintigraphy should be used in patients with PCa diagnosis.We aimed to reveal the relationship between bone scintigraphy results and the levels of GS and PSA in terms of the determination of metastasis in patients with PCa and to provide information about the necessity of using bone scintigraphy according to the results obtained. MethodsIn our study, scintigraphic images and file records (anamnesis, physical examination, PSA, GS, and radiological examination results, if any) of male patients who were histopathologically diagnosed with PCa and who came to our hospital's nuclear medicine department for whole-body bone scin- Relationship Between Bone Scintigraphy Results and Gleason Scores and Prostate-Specific Antigen LevelsIntroduction: We aimed to determine the relationship between bone scintigraphy results and Gleason score (GS) and prostate-specific antigen (PSA) levels in the detection of bone metastases in patients diagnosed with prostate cancer. Further, the predictive values of PSA levels and GSs were determined using bone scintigraphy.Methods: Seventy-three patients diagnosed with prostate cancer and who underwent bone scintigraphy for staging at our department between 2013 and 2015 were enrolled. The records of these patients were retrospectively reviewed for determining bone scin...

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Section: Discussionsupporting

confidence: 86%

Relationship Between Bone Scintigraphy Results and Gleason Scores and Prostate- Specific Antigen Levels

Şahin¹

2017

Istanbul Med J

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“…The staging process for patients diagnosed with prostate cancer includes a digital rectal examination (DRE), PSA, as well as pelvic computed tomography (CT) scan, pelvic lymphadenectomy and radionuclide bone scan (6). The detection of bone metastases using isotope bone scanning was first described using strontium in the early 1960s and it has long been the standard reference investigation for detecting bone metastases in prostate cancer (7). Technetium-99m labeled diphosphonates is very sensitive but its specificity is reduced in older men (7).…”

Section: Introductionmentioning

confidence: 99%

“…The detection of bone metastases using isotope bone scanning was first described using strontium in the early 1960s and it has long been the standard reference investigation for detecting bone metastases in prostate cancer (7). Technetium-99m labeled diphosphonates is very sensitive but its specificity is reduced in older men (7). Bone is the second most common site for metastatic deposits from prostate cancer and the skeleton is involved in 80-85% of patients who die of prostate cancer (8).…”

Section: Introductionmentioning

confidence: 99%

Do all patients with newly diagnosed prostate cancer need staging radionuclide bone scan? a retrospective study

et al. 2010

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Purpose: Define a group of patients with newly diagnosed prostate cancer, whose risk of bone metastasis is low enough to omit a bone scan staging study. Materials and Methods: From 2003 to 2009, the medical records of patients who were newly diagnosed with prostate cancer were retrospectively reviewed. The data collected included: age, digital rectal examination, serum prostate specific antigen (PSA), Gleason score, clinical T stage, and bone isotope scan. Patients were divided into two groups according to the results of bone isotope scan; positive group and negative group. A univariate and multivariate binary logistic regression was used to analyze the results. Results: Of the 106 patients, 98 had a complete data collection and were entered into the study. The median age of the patients was 70.5 years and patients with a positive bone scan was 74 years, significantly higher than for patients with negative scans (69 years) (p = 0.02). Bone metastasis was detected in 39 cases (39.7%). In all patients with clinical T1-2 stage, a Gleason score of < 8 and PSA ≤ 20 ng/mL, the bone isotope scans were negative. In univariate analysis, PSA (> 20 ng/mL) and Gleason score (> 7) were independently predictive of positive bone scan, while clinical stage was not. Conclusion: Staging bone scans can be omitted in patients with a PSA level of ≤ 20 ng/mL, and Gleason score < 8. Our results suggest that by considering the Gleason score and PSA, a larger proportion of patients with prostate cancer could avoid a staging bone scan.

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“…Prostate-specific antigen (PSA) level is an established prognostic marker that correlates with bone scan positivity, and various studies demonstrate a low risk of a positive bone scan in newly diagnosed patients with a low PSA level [3,4,[7][8][9][10][11][12][13]. Gleason score is also of important prognostic significance and has been shown to be an independent predictor of bone scan results on multivariate analysis [4,7,12,14].…”

mentioning

confidence: 99%

“…Gleason score is also of important prognostic significance and has been shown to be an independent predictor of bone scan results on multivariate analysis [4,7,12,14]. There is still a lack of consensus, however, on the referral criteria for bone scan in low-risk patients, with different authors supporting various cut-off levels of PSA, with some including Gleason score and clinical stage.…”

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confidence: 99%

Changing the referral criteria for bone scan in newly diagnosed prostate cancer patients

McArthur¹,

McLaughlin²,

Meddings³

2012

BJR

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Objectives: The aim of this study was to correlate the prostate-specific antigen (PSA) level and Gleason score with staging bone scan result in patients with a new diagnosis of prostate cancer in order to establish the feasibility of implementing the European Association Urology guidelines, which state that a bone scan may not be indicated when PSA ,20 in well-moderately differentiated tumours. Methods: We identified 633 patients retrospectively and 186 patients prospectively with a new diagnosis of prostate cancer undergoing a staging bone scan between March 2005 and January 2010. Patients were excluded if there was no Gleason score available or if the PSA level was checked over 3 months prior to bone scan. Bone scan results were analysed with respect to age, PSA level and Gleason score. In the case of an equivocal result, subsequent imaging was taken into consideration or the initial bone scan was re-reviewed. In persistently equivocal cases, all relevant imaging was assessed by a blinded panel of radiologists to allow a final decision to be made. Results: Of 672 patients aged 39-93 years (median 71 years), who fulfilled the inclusion criteria, 54 (8%) had evidence of bony metastases. PSA level and Gleason score were both independent predictors of bone scan positivity and their predictive value was additive p,0.01. None of the 357 patients with a PSA level of ,20 and a Gleason score of ,8 had a positive bone scan. Conclusion: Staging bone scans in newly diagnosed prostate cancer patients with a PSA level of ,20 and a Gleason score of ,8 can be safely omitted, with these criteria having a negative predictive value of 100% in our series.

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Broadening the criteria for avoiding staging bone scans in prostate cancer: a retrospective study of patients at the Royal Marsden Hospital

Cited by 57 publications

References 21 publications

Relationship Between Bone Scintigraphy Results and Gleason Scores and Prostate- Specific Antigen Levels

Relationship Between Bone Scintigraphy Results and Gleason Scores and Prostate- Specific Antigen Levels

Do all patients with newly diagnosed prostate cancer need staging radionuclide bone scan? a retrospective study

Changing the referral criteria for bone scan in newly diagnosed prostate cancer patients

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