title: Metastasis on bone scan with low prostate specific antigen (≤20 ng/ml) and Gleason's score (<8) in newly diagnosed Pakistani males with prostate cancer: should we follow Western guidelines?
abstract: OBJECTIVE
  To find out diagnostic correlation of prostate specific antigen (PSA) and Gleason' s score (GS) with bone metastasis (BM) in newly diagnosed prostate cancer (PC) patients in Pakistan.
  
  
  METHODS
  This retrospective study included 204 newly diagnosed PC patients who were referred for BS for staging.
  
  
  RESULTS
  The mean age, mean PSA and incidence of BM on BS were 71±09 years, 111.0±58.5 ng/ml and 67/204 (33%), respectively. The mean GS of the studied population was 7±1. According to PSA levels, patients were divided into 5 groups: <10 ng/ml (77/204), >10-≤20 ng/ml (4/204), >20-≤50 ng/ml (22/204), >50-≤100 (25/204) and >100 ng/ml (38/204). The incidence of positive BS (%) for BM and mean GS (score ±SD) for each group were 14%, 7±1; 10%, 6±1; 32%, 7±1; 56%, 8∓1 and 82%, 8±1 respectively (significant p value). PSA and GS were statistically significant predictors of BM on BS and their predictive value was additive (p<0.0001). Age was not a predictive factor (non-significant p value). Sensitivity and specificity of PSA at a cut-off 48 ng/ml were 68.3% and 86.1% respectively, while GS at a cut-off>6 was more sensitive (88.9%) and less specific (56.2%) for diagnosing BM.
  
  
  CONCLUSIONS
  (1) There is an overall increased incidence of BM in newly diagnosed patients with PC and even at serum PSA level≤20 ng/ml and GS<8; (2) PSA and GS are independent predictors for BM but age is not; (3) in view of possible aggressive behavior of PC in local population, one must be careful in adopting Western guidelines for using BS in newly diagnosed Asian males with PC having PSA≤20 ng/ml and GS <8.
authors: Department of Radiology, The Aga Khan University Hospital, Karachi, Islamic Republic of Pakistan. maseeh.uzzaman@aku.edu
authors: Maseeh Uz
authors: MU
authors: Zaman
authors: Nosheen
authors: N
authors: Fatima
authors: Zafar
authors: Z
authors: Sajjad
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D001859:Bone Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000556:secondary*; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010154:Pakistan; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D011877:Radionuclide Imaging; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen