191 CLINICAL YIELD OF INITIAL STAGING WORKUP FOR HIGH GRADE PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Staging1 Apr 2011191 CLINICAL YIELD OF INITIAL STAGING WORKUP FOR HIGH GRADE PROSTATE CANCER Kenneth M. Smith, Matthew J. O'Shaughnessy, Rachel M. Meuleners, and Joel W. Slaton Kenneth M. SmithKenneth M. Smith Minneapolis, MN More articles by this author , Matthew J. O'ShaughnessyMatthew J. O'Shaughnessy Minneapolis, MN More articles by this author , Rachel M. MeulenersRachel M. Meuleners Minneapolis, MN More articles by this author , and Joel W. SlatonJoel W. Slaton Minneapolis, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.261AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Current guidelines recommend staging of newly diagnosed prostate cancer patients with a bone scan and computed tomography (CT) or magnetic resonance imaging (MRI) scan when the prostate-specific antigen (PSA)>20 ng/ml, Gleason score ≥8, or stage ≥T3. These guidelines are based on studies with relatively low numbers of patients with high grade prostate cancer. Our objectives were to use a large patient population with high grade prostate cancer to (1) quantify the diagnostic yield of existing staging guidelines for this high risk population, and (2) determine if there is a subset of this population who could be accurately staged with limited imaging. METHODS We reviewed the records of all patients with high grade (Gleason 8–10) prostate cancer who underwent a bone scan and CT abdomen/pelvis at time of initial prostate cancer diagnosis from 2003 to 2009 at the Minneapolis Veterans Affairs Medical Center. The bone scan and/or CT findings were analyzed for correlation with variables including patient age, PSA at diagnosis, Gleason sum, clinical stage, and positive biopsy core volume. RESULTS Two hundred sixty patients had both CT and bone scan at time of diagnosis of high grade prostate cancer. 18.5% were positive for metastasis based on bone scan only and 19.6% were positive based on CT abdomen/pelvis only. When CT pelvis-only findings plus bone scan were considered, 18.8% had evidence of metastasis. Of those with a positive bone scan, 64.6% had CT findings consistent with metastatic disease. PSA>20 ng/ml, stage ≥cT2c, and core volume >50% were associated with increased risk of positive bone scan (P<0.001, P<0.001, P=0.018 respectively). Of patients with a negative bone scan, 9.1% had CT findings of metastasis. PSA>20 ng/ml (P<0.02) and stage ≥cT2c (P< 0.02) were associated with positive CT after negative bone scan. Interestingly, for all patients with a positive bone scan (n=48), follow-on CT staging did not yield information that changed clinical management. CONCLUSIONS Bone scans should be performed for staging on all patients with PSA>20 ng/ml, stage ≥cT2c, or Gleason ≥8. If the bone scan is positive, CT may be deferred as initial treatment would not be affected. If the bone scan is negative, CT imaging should be obtained due to the modest risk of additional findings. CT pelvis appears to be a suitable alternative to full CT abdomen/pelvis for accurately staging new high grade prostate cancer. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e79 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenneth M. Smith Minneapolis, MN More articles by this author Matthew J. O'Shaughnessy Minneapolis, MN More articles by this author Rachel M. Meuleners Minneapolis, MN More articles by this author Joel W. Slaton Minneapolis, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...