Abstract
BackgroundTo determine when a bone scintigraphy investigation is appropriate in patients with newly diagnosed prostate cancer (PCa).MethodsWe retrospectively reviewed 703 newly diagnosed PCa patients who were referred for bone scintigraphy. The association between age, prostate specific antigen (PSA), Gleason score (GS) and bone scintigraphy result were investigated by series of crude or stratified analysis.ResultsOverall, 15.08% (106/703) patients had bone metastases. PSA and GS between positive bone scan group and negative bone scan group were significantly different, while age was not. The incidence of bone metastasis in patient with PSA < 20 ng/ml or GS < 8 was less than 10%, but increased dramatically with rising PSA and upgrading GS. In multivariate analysis, PSA ≥ 20 ng/ml (OR = 5.10, 95%CI (2.12-12.27)) and GS ≥ 8 (OR = 3.61, 95%CI (1.55-8.41)) were independently predictive of positive bone scan.ConclusionsPatients with PSA ≥ 20 ng/ml or GS ≥ 8 were in higher risk of bone metastasis, bone scintigraphy was recommended. But a bone scintigraphy is of limited value in PCa patients with PSA ≤ 20 ng/ml and GS ≤ 7.
Highlights
To determine when a bone scintigraphy investigation is appropriate in patients with newly diagnosed prostate cancer (PCa)
The prostate-specific antigen (PSA) tests were within 30 days of bone scan, and the most recent bone scan results after prostate biopsy were included in the study to avoid bias caused by delayed diagnosis of bone metastases during tumor progession
The proportion of patients with highly suspicious findings of bone metastases based on bone scan in our cohort was 15.08% (106/703)
Summary
The current study was approved by ethics committee at our hospital It included newly diagnosed PCa patients from January 2011 to December 2014 in the Department of Urology at the First Affiliated Hospital of Zhejiang University in China. The consecutive 703 records of the patients were reviewed retrospectively for bone scan images, PSA levels and GS in biopsy, after excluding those with prior 5-alpha reductase inhibitors medication or surgical treatment for benign prostatic hyperplasia. The PSA tests were within 30 days of bone scan, and the most recent bone scan results after prostate biopsy were included in the study to avoid bias caused by delayed diagnosis of bone metastases during tumor progession. The primary outcome measured was the presence of bone metastasis on bone scintigraphy. All statistical analyses were performed using STATA, version 11.0 (StataCorp LP, College Station, TX, USA) and the outcome was considered significant only when the p value
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