303 WHEN TO PERFORM BONE SCAN IN PATIENTS WITH NEWLY DIAGNOSED PROSTATE CANCER: EXTERNAL VALIDATION OF A NOVEL RISK STRATIFICATION TOOL

Abstract

You have accessJournal of UrologyProstate Cancer: Staging1 Apr 2011303 WHEN TO PERFORM BONE SCAN IN PATIENTS WITH NEWLY DIAGNOSED PROSTATE CANCER: EXTERNAL VALIDATION OF A NOVEL RISK STRATIFICATION TOOL Cosimo De Nunzio, Costantino Leonardo, Andrea Cantiani, Alfonso Carluccini, Carlo De Dominicis, and Andrea Tubaro Cosimo De NunzioCosimo De Nunzio Rome, Italy More articles by this author , Costantino LeonardoCostantino Leonardo Rome, Italy More articles by this author , Andrea CantianiAndrea Cantiani Rome, Italy More articles by this author , Alfonso CarlucciniAlfonso Carluccini Rome, Italy More articles by this author , Carlo De DominicisCarlo De Dominicis Rome, Italy More articles by this author , and Andrea TubaroAndrea Tubaro Rome, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.396AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To externally validate the performance characteristics of a novel risk stratification tool recently proposed by Briganti et al. on the need for baseline staging bone scans in patients with newly diagnosed prostate cancer. METHODS From 2009 onwards, a consecutive series of patients with prostate cancer were enrolled. Indications for prostatic biopsy were a PSA > 4 ng/ml and/or a positive DRE. Patients were staged with total-body Tc 99m MDP scintigraphy performed regardless of baseline prostate cancer characteristics. The presence of skeletal metastasis (BM) on bone scan was defined when either solitary or multiple asymmetric areas of tracer increased uptake occurred. Patients with positive or equivocal bone scan findings also underwent CT or MRI to confirm the scintigraphy findings. No patient was on hormonal therapy at the time of the staging imaging. The AUC estimates were used to test the accuracy of the novel risk stratification tool (the regression tree (CART)) proposed by Briganti which recommended staging baseline bone scan for patients with a biopsy Gleason score >7 or with a PSA >10 ng/ml and palpable disease (cT2/T3) prior to treatment. The new tool was compared to the EAU guideline. The specificity, sensitivity, positive and negative predictive values of each model were also calculated. RESULTS A total of 313 patients were consecutively enrolled. Median age was 68 (range 49–95 years), median PSA was 7 ng/ml (range 0.81–2670); median prostatic volume was 40 cc (range 10–189). 20 (6.4%) patients presented a BM at the bone scan. Out of them, all patients presented at least a PSA > 30 ng/ml; 8 pts (40%) a Gleason score 7 and 12 (60%) a Gleason score >7; 10 pts (50%) presented a palpable disease. The AUC for the EAU guidelines was 0.64 (CI: 0.52–0.761). However, the novel CART model, was significantly more accurate (AUC: 0.75; CI: 0.632–0.859, p=0.001) than the EAU guideline (p<0.001). Table 1 reported the performance characteristics of CART and EAU guideline. Bone scans performed using the EAU and CART, No. (%) Rate of BM within the recommended patient group% (No) Overall accuracy% Sensitivity% Specificity% NPV% PPV% EAU 151/313(48%) 9.9%(815/151) 64% 75% 54% 97% 11% CART 90/313(29%) 16.6%(15/90) 75% 74% 74% 98% 16% CONCLUSIONS Our study validated the novel risk stratification tool recently proposed by Briganti and we confirmed as it presented a higher accuracy for baseline staging bone scan when compared to the EAU guideline. Furthermore, with this highly accurate approach we would further reduce (about 60%) the use of staging baseline bone scans. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e123 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cosimo De Nunzio Rome, Italy More articles by this author Costantino Leonardo Rome, Italy More articles by this author Andrea Cantiani Rome, Italy More articles by this author Alfonso Carluccini Rome, Italy More articles by this author Carlo De Dominicis Rome, Italy More articles by this author Andrea Tubaro Rome, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...