title: Is prostate-specific antigen a reliable marker of bone metastasis in patients with newly diagnosed cancer of the prostate?
abstract: OBJECTIVE
  Staging in patients with newly diagnosed cancer of the prostate has significant ramifications in the management of the disease. At present, measurement of serum prostate-specific antigen (PSA) concentration and radionuclide bone scintigraphy are two important procedures in the metastatic work-up of these patients. We evaluated the efficacy of PSA as a staging marker to discriminate prostate cancer patients with and without bone metastases.
  
  
  METHODS
  In a retrospective study, 359 prostate cancer patients with (n = 40) and without (n = 319) bone metastases were analyzed. In all patients the initial PSA measurement as well as the radionuclide bone scan were evaluated.
  
  
  RESULTS
  Patients without bone metastases demonstrated a median serum PSA concentration of 12 ng/ml, whereas those with bone metastases revealed a median serum PSA concentration of 59 ng/ml, with 7 patients demonstrating a serum PSA concentration of < 10 ng/ml. This resulted in a negative predictive value of 96%. In addition, only 40% of these patients with bone metastases demonstrated a serum PSA concentration of > 100 ng/ml, which resulted in a positive predictive value of 50%.
  
  
  CONCLUSIONS
  The serum PSA concentration seems only to provide limited information with regard to the presence of bone metastasis in patients with newly diagnosed cancer of the prostate. We therefore question whether a staging radionuclide bone scan may be omitted in patients with a serum PSA value of < 10 ng/ml.
authors.affiliation: Department of Urology, University of Aachen Medical School, Germany.
authors.forename: J M
authors.initials: JM
authors.lastname: Wolff
authors.forename: M
authors.initials: M
authors.lastname: Zimny
authors.forename: H
authors.initials: H
authors.lastname: Borchers
authors.forename: J
authors.initials: J
authors.lastname: Wildberger
authors.forename: U
authors.initials: U
authors.lastname: Buell
authors.forename: G
authors.initials: G
authors.lastname: Jakse
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000175:diagnosis* / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000556:secondary; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D011897:Random Allocation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen