Abstract
BackgroundBone Scan Index (BSI) is a quantitative measurement of tumour burden in the skeleton calculated from bone scan images. When analysed at the time of diagnosis, it has been shown to provide prognostic information on survival in men with metastatic prostate cancer (PCa). In this study, we evaluated the prognostic value of BSI during androgen deprivation therapy (ADT).MethodsProstate cancer patients who were at high risk of a poor outcome and who had undergone bone scan at the time of diagnosis and during ADT were recruited from two university hospitals for a retrospective study. BSI at baseline and follow-up were calculated using an automated software package (EXINIbonebsi). Associations between BSI, other prognostic biomarkers and overall survival (OS) were evaluated using a Cox proportional hazards regression model.ResultsOne hundred forty-six PCa patients were included in the study. A total of 102 patient deaths were registered, with a median survival time after the follow-up bone scan of 2.4 years (interquartile range (IQR) =0.8 to 4.4). Both at baseline and during ADT, BSI was significantly associated with OS in univariate and multivariate analyses. When BSI was added to a prognostic base model including age, prostate-specific antigen, clinical tumour stage and Gleason score, the concordance index increased from 0.73 to 0.77 (p =0.0005) at baseline and from 0.77 to 0.82 (p <0.0001) during ADT.ConclusionsAutomated BSI during ADT is an independent prognostic indicator of OS in PCa patients with bone metastasis. It represents an emerging imaging biomarker that can be used in a prognostic model for risk stratification of PCa patients at the time of diagnosis and at later stages of the disease. BSI could then help physicians identify patients who could benefit from more aggressive therapies.
Highlights
Bone Scan Index (BSI) is a quantitative measurement of tumour burden in the skeleton calculated from bone scan images
The androgen deprivation therapy administrated to these patients in most cases comprised bicalutamide (CasodexTM, AstraZeneca plc, London, UK) or flutamide (EulexinTM, Schering-Plough Corporation, Kenilworth, NJ, USA), with or without a gonadotropin-releasing hormone analogue (GNRH) agonist such as leuprorelin (EligardTM, EnantonTM or ProcrenTM) and goserelin acetate (Zoladex®)
BSI could help physicians identify patients who could benefit from more aggressive therapies (Figure 4)
Summary
Bone Scan Index (BSI) is a quantitative measurement of tumour burden in the skeleton calculated from bone scan images. Despite the increasing availability of advanced imaging modalities such as magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT), bone scan (BS) is still the most commonly used method of assessing metastatic spread to the skeleton and monitoring response to treatment [5,6]. It has been used for many years, but there is still no standardised way of describing the images other than in vague terms, i.e. the presence or absence of tumour spread to the skeleton (M1 or M0)
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