When is a bone scan study appropriate in asymptomatic men diagnosed with prostate cancer?
OBJECTIVE
To determine when a bone scan investigation is appropriate in asymptomatic men diagnosed with prostate cancer.


METHODS
Between November 2005 and July 2006, 317 men with prostate cancer underwent a bone scan study; 176 men fulfilled the inclusion criteria. Prostate-specific antigen (PSA) cut-offs as well as univariate and multivariate logistic regression analyses using digital rectal examination finding, biopsy Gleason scores and age were performed to determine when a bone scan study is likely to be of value.


RESULTS
Only 1/61 men (1.6%) with a serum PSA 20 ng/mL had a positive bone scan. However, 2/38 men (4.7%) with a serum PSA 20.1-40.0 ng/mL, 3/20 men (15%) with a serum PSA 40.1-60.0 ng/mL, 7/19 men (36.8%) with a serum PSA 60.1-100.0 ng/mL and 19/38 men (50%) with a serum PSA > 100.0 ng/mL had positive bone scans. Univariate and multivariate logistic regression analyses were uninformative in these groups.


CONCLUSIONS
Based on our findings, a bone scan is of limited value in asymptomatic prostate cancer patients presenting PSA =or< 20 ng/mL. Therefore, this investigation can be eliminated unless a curative treatment is contemplated. Furthermore, digital rectal examination finding, biopsy Gleason score and age are unhelpful in predicting those who might harbor bone metastasis.
Pal
Raj P
RP
Department of Urology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4WP, UK. rppal@doctors.org.uk
Thiruudaian
Thivyaan
T
Khan
Masood A
MA
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D013669:Technetium Tc 99m Medronate
D019275:Radiopharmaceuticals; D017430:Prostate-Specific Antigen; D013669:Technetium Tc 99m Medronate