Stratification of patients with metastatic prostate cancer based on extent of disease on initial bone scan

Abstract

Most patients with metastatic prostate cancer will have metastasis to bone. Such patients are best monitored by serial radionuclide bone scans. One hundred sixty six men with bone metastasis from prostate cancer who received androgen deprivation therapy had their pretreatment bone scans reviewed using a semiquantitative grading system based upon the extent of disease (EOD) observed on the scan. The EOD on the scan correlated with survival. The 2-year survival rates for EOD I to IV were 94%, 74%, 68%, and 40%, respectively. The survival of patients in categories EOD I and IV significantly differed from the other categories. Men with metastatic prostate cancer entered into trials designed to evaluate the impact of treatment on survival should be stratified based upon the EOD on the bone scan. This analysis also indicates that patients in the EOD IV category have a particularly poor prognosis and may be candidates for alternative treatments.

The comparative values of bone marrow aspirate and trephine for obtaining bone scan-targeted metastases from hormone-refractory prostate cancer

“…Tumor load, as indirectly assessed by the combination of serum PSA, 19 bone scan lesion count 20 and FBC results, does not reveal results different to many other patients seen in the clinic with progressive prostate cancer. We did not perform reverse transcriptase polymerase chain reactions on any of the blood samples obtained, and therefore do not have data on circulating tumour load in a more quantitative fashion.…”

Percentage of the positive area of bone metastasis is an independent predictor of disease death in advanced prostate cancer

“…The total number of lesions was determined by visual counting of each discrete lesion using the method described previously (Soloway et al, 1988), and the metastatic findings on bone scans were classified into four groups in accordance with the EOD as follows: grade 1, less than six bone metastases (a lesion occupying the entire vertebral body was counted as two lesions); grade 2, 6 -20 bone metastases; grade 3, more than 20 bone metastases, but less than a 'super scan' (diffuse symmetrical uptake without visualisation of the kidneys); and grade 4, super scan or its equivalent (involvement of greater than 75% of the ribs, vertebrae and pelvic bones). The total number of lesions on the 'super scan' was counted as 100 in this study.…”

“…The presence of bone metastasis is of prognostic importance in prostate cancer, because the extent of the disease (EOD) on a bone scan significantly affects overall survival (Soloway et al, 1988;Ernst et al, 1991). Bone scanning remains the most effective radiological procedure for detecting bone metastasis with 1% false-negative rate (Schaffer and Pendergrass, 1976), and for monitoring progression of bone metastasis.…”

“…Visual analysis of bone scans is a common method to estimate the extent of skeletal disease. Several studies have proposed a grading classification for the bone metastasis based on the pattern of uptake on the bone scan (Amico et al, 1991;Chybowski et al, 1991) or based on the quantitation of the number of sites (Soloway et al, 1988;Erdi et al, 1997). However, quantitative analysis of all bone metastases is a time-consuming task because patients with advanced prostatic cancer usually have multiple disease sites.…”

Octreotide scintigraphy and Chromogranin A do not predict clinical response in patients with octreotide acetate-treated hormone-refractory prostate cancer

“…Each bone scintigraphy was graded according to the classification of Soloway, where 0 represents normal or abnormal due to benign disease, 1 represents less than 6 metastases, of which each is less than 50% the size of a vertebral body, 2 represents between 6 and 20, size of lesion as described, 3 represents more than 20, but less than a super scan and 4 represents super scan or its equivalent (more than 75% of the ribs, vertebrae and pelvic bones). 17 …”