title: Is bone scintigraphy necessary in initial staging of prostate cancer patients?
abstract: Our aim was to determine whether serum prostate specific antigen (PSA) and total Gleason score (GS) on biopsy in newly diagnosed prostate cancer (PCa) can predict osseous metastases and eliminate the need for a bone scan as a routine procedure in initial staging. We studied retrospectively 155 patients with previously untreated PCa who underwent bone scintigraphy. Relationship between PSA, GS and bone metastases was examined. Sensitivity, specificity, likelihood ratio (LR) and odds ratio (OR) were calculated with corresponding 95% conidence interval. Results showed that thirty of all bone scans (19.35%) were positive for metastases. This proportion was significantly higher in patients with PSA>20ng/mL (31.66% , P=0.002) vs. PSA<10ng/mL (10.52%). For PSA<10ng/mL as well as 10ng/mL≤ PSA≤ 20ng/mL the test was not a predictor for bone metastases (OR=0.36; OR=0.55). For PSA>20 ng/mL (OR=3.53) the likelihood of bone metastases was increased by 13% . The proportion of positive scintigraphy findings was significantly lower in patients with GS≤ 7 (11.47% ) vs. GS≥ 8 (48.48% , P<0.0001). The GS≥ 8 was highly predictive for bone metastases (OR=7.260). The analysis showed that GS≥ 8 increases the risk of bone metastases by 29%. In conclusion, bone scintigraphy is not necessary in asymptomatic patients with localized disease, GS≤ 6 and PSA<10ng/mL, because of the negligible risk of bone metastases in that stage. Higher levels of GS and PSA may predict bone metastases.
authors.affiliation: Institute of Nuclear Medicine, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia. lilaj2805@gmail.com
authors.forename: Ljiljiana
authors.initials: L
authors.lastname: Jaukovic
authors.forename: Boris
authors.initials: B
authors.lastname: Adjinovic
authors.forename: Snezana
authors.initials: S
authors.lastname: Cerovic
authors.forename: Mirjana
authors.initials: M
authors.lastname: Joksimovic
authors.forename: Zivko
authors.initials: Z
authors.lastname: Soldatovic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary*; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D011859:Radiography; D011877:Radionuclide Imaging / Q000706:statistics & numerical data*; D013669:Technetium Tc 99m Medronate / Q000008:administration & dosage; D019564:Unnecessary Procedures
chemical_list: D017430:Prostate-Specific Antigen; D013669:Technetium Tc 99m Medronate