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

Abstract

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.

Correlation between Low Gleason Score and Prostate Specific Antigen Levels with Incidence of Bone Metastases in Prostate Cancer Patients: When to Omit Bone Scans?

“…They found that the recommendation had 99% negative predictive value, 70.8% sensitivity and 88.7% specificity. Moreover, recent study by McArthur et al (2012) with 672 PC patients found negative predictive value of 100% by applying EAU guidelines. These recent studies were conducted in Europe, which had different PC patients' characteristics than PC patients in Asia, including Indonesia.…”

“…Even it was still higher compared to the other developing Asian nations, such as Pakistan (33%) (Zaman et al, 2011). This high number of BM could be due to several causes: most of patients come with advance stages [in Jakarta, 62% prostate cancer patients came with metastatic disease (Akaza et al, 2012)], majority of the patients came with high PSA and GS at diagnosis, and BS was performed to all of PC patients regardless of the PSA and GS value (McArthur et al, 2012). The other studies that had high percentage of BM in western countries were conducted in Italy in 1995 (45.8%) and in Norway in 1997 (44.6%) (Rudoni et al, 1995;Haukaas et al, 1997).…”

Can PSA Predict Bone Metastasis amongst Newly Diagnosed Prostate Cancer Patients?

“…Just as the AUA and the EUA guidelines are different, several studies have come up with different cut offs of PSA as being predictive of bone metastases as shown in the literature review section above. This can be attributed to the variations in PSA dynamics observed in different populations (9,(11)(12)(13). Most published studies have lower PSA cut off (<20ng/ml) as a predictor of negative bone scans (12)(13)(14).…”

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

“…These values were, respectively, 5.5% and 34.2% and this was found consistent with the studies conducted by determining Figure 1. BM+: there is bone metastasis; BM-: there is no bone metastasis; Combined group 1: patients with PSA>20 ng/mL and GS≤6; Combined group 2: patients with PSA>20 ng/mL and GS>6; Combined group 3: patients with PSA≤20 ng/mL and GS≤6; Combined group 4: patients with PSA≤20 ng/mL and GS>6. the cutoff value of the PSA level as 20 ng/mL (8,12). In the study conducted by Zaman et al (7), it was reported that the incidence of bone metastasis was higher in patients with a PSA level below 20 ng/mL.…”