Correlation of serum prostate specific antigen levels and bone scintigraphy in carcinoma prostate

Abstract

Serum prostate specific antigen (PSA) has been suggested as an accurate means of monitoring prostate cancer. An analysis of PSA levels and bone scan findings was carried out in a heterogeneous group of patients with a view to determine whether PSA can accurately predict bone metastases in carcinoma prostate. Of the 48 patients studied, all 10 untreated cases had elevated PSA levels, eight having bone metastases. In 29 cases on follow-up after treatment of the primary, 10 out of 11 cases with normal PSA had a negative bone scan. In the nine who received hormonal therapy, the PSA levels were generally lower than others in the study group. Two out of four with normal PSA had bone metastases. In 26 cases with positive bone scans, 23 had elevated PSA levels (mean 109.9 ng ml-1). Among 22 patients who had normal bone scans, all 10 with high PSA were found to have soft tissue disease which could explain the elevated PSA. In those with normal PSA, 12 out of 15 patients had negative scans. PSA has fairly high sensitivity (86.5%) and negative predictive value (80%). But it suffers from low specificity (54.5%) and low positive predictive value (69.7%) for bone metastases. In an untreated patient with elevated PSA, a bone scan may be required to exclude bone metastases, whereas during follow-up after treatment, a normal PSA level may obviate a "routine" bone scan.

Non-invasive Quantitative Characterization of Skeletal Metastasis in Carcinoma Prostate by Tc99m MDP Bone Scans Using Dr. V. Siva’s Retention Ratio in Correlation with Serum PSA Levels

“…In a study of 48 patients of Ca. Prostate the mean serum PSA level was >109.9 ng/ml in the positive bone metastasis group and it was >54.7 ng/ml in the negative group as documented by Oommen et al [14]. The serum PSA level in the bone scan positive group was almost TWICE the serum PSA value in the negative bone scan group in this study too as shown by our reported values.…”

Value of prostate specific antigen in predicting the existence of bone metastasis in scintigraphy

“…Thus, some authors suggest the possibility of using PSA serum levels to predict possible scintigraphic findings (4,5,8,9,(11)(12)(13). Nevertheless, up to the moment, the literature presents disagreeing results in what concerns the cutting point to be adopted to predict the presence or absence of bone metastasis in prostate adenocarcinoma (1,10,14,15).…”

Cintilografia óssea no câncer de próstata

“…No curso da terapia hormonal (15) , pacientes com níveis normais ou baixos de PSA podem ter evidência de progressão metastá-tica. Nestes casos, a cintilografia óssea é fundamental na detecção das metástases.…”

“…Com o advento do antígeno prostático específico (PSA), surgiram novas abordagens e grandes discussões sobre o papel e importância da cintilografia óssea no estadiamento e acompanhamento dos pacientes com câncer de próstata (6)(7)(8)(9)(10)(11)(12)(13)(14)(15) . Neste artigo foram revisados artigos da literatura no período de 1976 até 2003, para se chegar ao papel atual da cintilografia óssea na avaliação de tais pacientes e sua correlação com o PSA, seja no seu estadiamento, no seguimento sistemático ou no estudo de pacientes sintomáticos no seu curso evolutivo.…”