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

Abstract

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...