BACKGROUND: International guidelines uniformly suggest no routine staging of bone metastasis in patients with bone scintigraphy (BS) in low-risk prostate cancer (PCa).
These recommendations are based on retrospective investigations only. In addition, BS has most often been reported as a definitive investigation with no room for equivocal cases.
OBJECTIVE: The objective of this study was to determine the diagnostic value of BS in a large cohort of consecutive patients with newly diagnosed PCa.
DESIGN, SETTING, AND PARTICIPANTS: Over a period of 1.5 years in 2008 to 2009, consecutive patients with newly diagnosed PCa were enrolled in a noninterventional, multicenter, observational study. All patients had a whole-body, planar BS. Clinical history and clinical, pathological, and biochemical data were obtained from electronic patient files and questionnaires.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Bone scintigraphy was classified into 4 categories as nonmalignant, equivocal, likely malignant, or multiple metastasis. The primary end point was final imaging, which was a composite end point of BS and additional CT and MRI investigations.
RESULTS AND LIMITATIONS: A total of 635 eligible patients were recruited. Their median prostate-specific antigen (PSA) was 15 ng/mL, median Gleason was 7, and 80% of patients had local disease (T1 or T2). The proportion of nonmalignant BS was 61%, equivocal scans 26%, and likely or definitive metastasis 13%. A total of 154 patients had additional CT or MRI investigations. The final imaging diagnosis showed a prevalence of bone metastases in 87 (13.7%) of 635 patients. No bone metastases were observed in (1) patients with PSA of less than 10 ng/mL, independently of the clinical T stage and Gleason score (n = 212) and (2) PSA of less than 20 ng/mL if T stage is less than T3 and Gleason score is less than 8 (n = 97). Approximately 50% of the patients enrolled in this study met these criteria.
CONCLUSION: This is the first prospective trial to demonstrate that BS can be avoided in patients with low-risk PCa.
Written by:
Zacho HD, Barsi T, Mortensen JC, Mogensen MK, Bertelsen H, Josephsen N, Petersen LJ. Are you the author?
Department of Clinical Physiology, Viborg Hospital, Viborg; Department of Nuclear Medicine, Aalborg University Hospital, Aalborg; Department of Urology, Viborg Hospital, Viborg; Departments of Nuclear Medicine, and Urology, Regional Hospital West Jutland, Herning; Departments of Clinical Physiology, and Nuclear Medicine, and Urology, Randers Hospital, Randers; and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Reference: Clin Nucl Med. 2013 Nov 7. Epub ahead of print.
PubMed Abstract
PMID: 24217537
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