Abstract
Purpose: The objective of the present study was to correlate the prostate-specific antigen (PSA) level and Gleason score with the baseline bone scan results in patients with newly diagnosed prostate cancer and try to determine a group of patients whose risk of bone metastases is low enough to omit safely this staging modality. Methods: This retrospective study included 84 consecutive patients with newly diagnosed prostate cancer (Pca) who underwent a staging bone scan in Nuclear Medicine department between August 2013 and August 2014. Data were collected on age, bony pain, prostate-specific antigen (PSA) level and Gleason score, then, bone scan results were analyzed with respect to these parameters. Bone scan was recorded as positive, negative or equivocal. In case of equivocal lesions, a single-photon emission computed tomography combined with computed tomography (SPECT-CT) was performed allowing a better morphological precision. Results: The median age of the patients was 71, 38 years. Bone metastases were detected in 41 patients (49% of cases), bony pain was a reliable presenting sign of skeletal involvement. Both prostate-specific antigen (PSA) level and Gleason score were independent predictors of positive bone scan. However, the combination of these two parameters enhanced predictability of bone scan results. According to this study, the risk to develop a bone metastasis was very low in asymptomatic patients with PSA level < 20 ng/ml irrespective of the Gleason score or with PSA level < 30 ng/ml associated to a Gleason score < 7. Conclusion: The present study discourages the routine use of bone scan as a pre-treatment staging modality in asymptomatic patients with PSA level < 20 ng/ml irrespective of the Gleason score or with PSA level < 30 ng/ml associated to a Gleason score < 7, allowing considerable cost savings and decreasing time from diagnosis to treatment.
Highlights
Prostate cancer is considered currently the most common malignancy and the second leading cause of cancer death among men aged over 50 years in developed countries
2 Chorfi et al.: The value of Gleason score and prostate-specific antigen level tion of Urology (EAU) guidelines, updated in April 2014, state that bone scan is recommended in asymptomatic patients only if the PSA level > 10 ng/mL or Gleason score ≥ 8 or clinical stage ≥ T3
According to the European Association of Urology (EAU) guidelines, updated in April 2014, bone scan is recommended in asymptomatic patients only if the PSA level > 10 ng/mL or Gleason score ≥ 8 or clinical stage ≥ T3
Summary
Prostate cancer is considered currently the most common malignancy and the second leading cause of cancer death among men aged over 50 years in developed countries It is one of the few cancers that grow so slowly that it may never be life threatening, it can show an aggressive pattern that may spread and cause the death of patients mainly due to malignant involvement of bone.[1, 2] early diagnosis of metastatic bone involvement in prostate cancer is crucial for selecting appropriate therapy, to assess the patient’s prognosis, and to evaluate the efficacy of bone-specific treatments that may reduce future bone associated morbidity.[1]. Nuclear bone scan is the investigation of choice to evaluate bone metastases. It has a great sensitivity; it lacks specificity prompting the need for further imaging that, in turn, create anxiety for patients, add considerable cost, and delay therapy.[3]. The test soon became the most commonly used screening method for the diagnosis and follow-up in the management of prostate cancer patients.[1, 3] More recent studies demonstrated Gleason grade to be an independent predictor for positive bone scan and that its utilization may avoid a considerable number of bone scans.[4]
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