Limited value of bone scintigraphy and computed tomography in assessing biochemical failure after radical prostatectomy.
OBJECTIVE
To define the utility of bone scan and computed tomography (CT) in the evaluation of patients with biochemical recurrence after radical prostatectomy.


METHODS
A retrospective analysis of the Center for Prostate Disease Research database was undertaken to identify patients who underwent radical prostatectomy between 1989 and 1998. Patients who developed biochemical recurrence (two prostate-specific antigen [PSA] levels greater than 0.2 ng/mL) and underwent either bone scan or CT within 3 years of this recurrence were selected for analysis. The preoperative clinical parameters, pathologic findings, serum PSA levels, follow-up data, and radiographic results were reviewed.


RESULTS
One hundred thirty-two patients with biochemical recurrence and a bone scan or CT scan were identified. Of the 127 bone scans, 12 (9.4%) were positive. The patients with true-positive bone scans had an average PSA at the time of the bone scan of 61.3 +/- 71.2 ng/mL (range 1.3 to 123). Their PSA velocities, calculated from the PSA levels determined immediately before the radiographic studies, averaged 22.1 +/- 24.7 ng/mL/mo (range 0.14 to 60.0). Only 2 patients with a positive bone scan had a PSA velocity of less than 0.5 ng/mL/mo. Of the 86 CT scans, 12 (14.0%) were positive. On logistic regression analysis, PSA and PSA velocity predicted the bone scan result (P <0.001 each) and PSA velocity predicted the CT scan result (P = 0.047).


CONCLUSIONS
Patients with biochemical recurrence after radical prostatectomy have a low probability of a positive bone scan (9.4%) or a positive CT scan (14.0%) within 3 years of biochemical recurrence. Most patients with a positive bone scan have a high PSA level and a high PSA velocity (greater than 0.5 ng/mL/mo).
Kane
Christopher J
CJ
Department of Urology, Naval Medical Center San Diego, San Diego, California, USA.
Amling
Christopher L
CL
Johnstone
Peter A S
PA
Pak
Nali
N
Lance
Raymond S
RS
Thrasher
J Brantley
JB
Foley
John P
JP
Riffenburgh
Robert H
RH
Moul
Judd W
JW
D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000000981:diagnostic imaging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D011877:Radionuclide Imaging / Q000706:statistics & numerical data; D012008:Recurrence; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data
D017430:Prostate-Specific Antigen