Departments of Radiology, Ayr Hospital, Ayr UK.
To correlate 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 European Association Urology guidelines which state that a bone scan may not be indicated when PSA< 20 in well to moderately differentiated tumours.
We identified 633 patients retrospectively and 186 patients prospectively with a new diagnosis of prostate cancer undergoing staging bone scan between March 2005 and January 2010. Patients were excluded if there was no Gleason score available or if PSA was checked over 3 months prior to bone scan. Bone scan results were analysed with respect to age, PSA 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.
Of 672 patients, aged 39-93 (median 71 years), who fulfilled the inclusion criteria, 54 (8%) had evidence of bony metastases. PSA and Gleason score were both independent predictors of bone scan positivity and their predictive value was additive p <  0.01. None of 357 patients with PSA < 20 and Gleason sum <8 had a positive bone scan.
Staging bone scan in newly diagnosed prostate cancer patients with PSA < 20 and Gleason sum < 8 can be safely omitted with this criteria having a negative predictive value of 100% in our series.
McArthur C, McLaughlin G, Meddings RN. Are you the author?
Reference: Br J Radiol. 2011 Feb 8. Epub ahead of print.