title: Do all patients with newly diagnosed prostate cancer need staging radionuclide bone scan? A retrospective study.
abstract: OBJECTIVE
  Define a group of patients with newly diagnosed prostate cancer, whose risk of bone metastasis is low enough to omit a bone scan staging study.
  
  
  METHODS
  From 2003 to 2009, the medical records of patients who were newly diagnosed with prostate cancer were retrospectively reviewed. The data collected included: age, digital rectal examination, serum prostate specific antigen (PSA), Gleason score, clinical T stage, and bone isotope scan. Patients were divided into two groups according to the results of bone isotope scan; positive group and negative group. A univariate and multivariate binary logistic regression was used to analyze the results.
  
  
  RESULTS
  Of the 106 patients, 98 had a complete data collection and were entered into the study. The median age of the patients was 70.5 years and patients with a positive bone scan was 74 years, significantly higher than for patients with negative scans (69 years) (p=0.02). Bone metastasis was detected in 39 cases (39.7%). In all patients with clinical T1-2 stage, a Gleason score of <8 and PSA≤20 ng/mL, the bone isotope scans were negative. In univariate analysis, PSA (>20 ng/mL) and Gleason score (>7) were independently predictive of positive bone scan, while clinical stage was not.
  
  
  CONCLUSIONS
  Staging bone scans can be omitted in patients with a PSA level of ≤20 ng/mL, and Gleason score<8. Our results suggest that by considering the Gleason score and PSA, a larger proportion of patients with prostate cancer could avoid a staging bone scan.
authors.affiliation: Department of General Surgery and Urology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan. alghazo@just.edu.jo
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Al-Ghazo
authors.forename: Ibrahim F
authors.initials: IF
authors.lastname: Ghalayini
authors.forename: Rami S
authors.initials: RS
authors.lastname: Al-Azab
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Bani-Hani
authors.forename: Alaa
authors.initials: A
authors.lastname: Barham
authors.forename: Yazan
authors.initials: Y
authors.lastname: Haddad
mesh_terms: D000367:Age Factors; D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011877:Radionuclide Imaging; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen