title: Is it suitable to eliminate bone scan for prostate cancer patients with PSA ≤ 20 ng/mL?
abstract: OBJECTIVE
  We evaluated the relationship between bone metastasis (BM) and clinical or pathological variables, including the serum prostate-specific antigen (PSA) concentration.
  
  
  METHODS
  This retrospective study included 579 consecutive patients with newly diagnosed prostate cancer (Pca) who underwent a bone scan study at our institution between 2002 and 2010. We used receiver operating characteristics curves to evaluate accuracy of bone metastasis between serum PSA 10 and 20 ng/mL.
  
  
  RESULTS
  A positive bone scan result was found in 83 men (14.3%) with PCa. However, 27 men (4.6%) with serum PSA between 10 and 20 ng/mL, 29/579 men (5.0%) with GS ≤ 7, and 21/83 (25.3%) with serum PSA ≤ 20 ng/mL and Gleason score (GS) ≤ 7 had positive bone scans. In the logistic regression analyses, clinical T stage (odds ratio [OR] = 3.26; 95% CI, 2.29-4.33; P = 0.021), GS (OR = 3.41; 95% CI, 2.91-4.63; P = 0.019), and serum PSA (OR = 8.37; 95% CI, 3.91-19.21; P < 0.001) were predictive factors of detecting the BM. When the serum PSA concentration ≤20 ng/mL and GS ≤ 7, AUC value of bone scans for the detection of BM was 0.640 (P = 0.020; 95% CI, 0.563-0.717). With serum PSA at 10 ng/mL and GS ≤ 7, the AUC values of bone scans were 0.828 (P < 0.001; 95% CI, 0.773-0.883).
  
  
  CONCLUSIONS
  Bone scans might be necessary in men with serum PSA between 10 and 20 ng/mL. New guidelines for eliminating bone scans in patients with newly diagnosed Pca are needed, especially in Asians.
authors.affiliation: Department of Urology, Yonsei University Health System, Gangnam Severance Hospital, Yongdong, P.O. Box 1217, Seoul, Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Lee
authors.forename: Mun Su
authors.initials: MS
authors.lastname: Chung
authors.forename: Kyung Kgi
authors.initials: KK
authors.lastname: Park
authors.forename: Chan Dong
authors.initials: CD
authors.lastname: Yom
authors.forename: Dae Hoon
authors.initials: DH
authors.lastname: Lee
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000556:secondary*; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*; D011877:Radionuclide Imaging; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen