title: Limited value of bone scintigraphy and computed tomography in assessing biochemical failure after radical prostatectomy.
abstract: 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).
authors.affiliation: Department of Urology, Naval Medical Center San Diego, San Diego, California, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Amling
authors.forename: Peter A S
authors.initials: PA
authors.lastname: Johnstone
authors.forename: Nali
authors.initials: N
authors.lastname: Pak
authors.forename: Raymond S
authors.initials: RS
authors.lastname: Lance
authors.forename: J Brantley
authors.initials: JB
authors.lastname: Thrasher
authors.forename: John P
authors.initials: JP
authors.lastname: Foley
authors.forename: Robert H
authors.initials: RH
authors.lastname: Riffenburgh
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
mesh_terms: 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
chemical_list: D017430:Prostate-Specific Antigen