title: Toward better use of bone scans among men with early-stage prostate cancer.
abstract: OBJECTIVE
  To evaluate the performance of published guidelines compared with that of current practice for radiographic staging of men with newly diagnosed prostate cancer.
  
  
  METHODS
  Using data from the Michigan Urological Surgery Improvement Collaborative clinical registry, we identified 1509 men diagnosed with prostate cancer from March 2012 through June 2013. Clinical data included age, prostate-specific antigen (PSA) level, Gleason score (GS), clinical trial stage, number of biopsy cores, and bone scan (BS) results. We then fit a multivariate logistic regression model to examine the association between clinical variables and the occurrence of bone metastases. Because some patients did not undergo BS, we used established methods to correct for verification bias and estimate the diagnostic accuracy of published guidelines.
  
  
  RESULTS
  Among 416 men who received a BS, 48 (11.5%) had evidence of bone metastases. Patients with bone metastases were older, with higher PSA levels and GS (all P <.05). In multivariate analyses, PSA (P <.001) and GS (P = .004) were the only independent predictors of positive BS. Guidelines from the American Urological Association and the National Comprehensive Cancer Network demonstrated similar performance in detecting bone metastases in our population, with fewer negative study results than those of the European Association of Urology guideline. Applying the American Urological Association recommendations (ie, image when PSA level >20 ng/mL or GS ≥ 8) to current clinical practice, we estimate that <1% of positive study results would be missed, whereas the number of negative study results would be reduced by 38%.
  
  
  CONCLUSIONS
  Based on current practice patterns, more uniform application of existing guidelines would ensure that BS is performed for almost all men with bone metastases, while avoiding many negative imaging studies.
authors.affiliation: Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI.
authors.forename: Selin
authors.initials: S
authors.lastname: Merdan
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Womble
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI.
authors.forename: David C
authors.initials: DC
authors.lastname: Miller
authors.affiliation: Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI.
authors.forename: Christine
authors.initials: C
authors.lastname: Barnett
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI.
authors.forename: Zaojun
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Linsell
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI.
authors.forename: James E
authors.initials: JE
authors.lastname: Montie
authors.affiliation: Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI. Electronic address: btdenton@umich.edu.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Denton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011471:Prostatic Neoplasms / Q000473:pathology*; D011877:Radionuclide Imaging
references.citation: World J Urol. 2012 Apr;30(2):265-9
references.pmid: 21779835
references.citation: Eur Urol. 2010 Apr;57(4):551-8
references.pmid: 20034730
references.citation: Urol Int. 2013;91(2):160-4
references.pmid: 23548369
references.citation: Jpn J Clin Oncol. 2007 Oct;37(10):788-92
references.pmid: 17911377
references.citation: Int J Radiat Oncol Biol Phys. 2000 Dec 1;48(5):1443-6
references.pmid: 11121646
references.citation: Cancer. 2002 Feb 15;94(4):964-72
references.pmid: 11920464
references.citation: Asian Pac J Cancer Prev. 2011;12(6):1529-32
references.pmid: 22126493
references.citation: J Urol. 2007 Jun;177(6):2106-31
references.pmid: 17509297
references.citation: Urology. 1996 May;47(5):708-12
references.pmid: 8650870
references.citation: Eur Urol. 1999;35(3):223-7
references.pmid: 10072624
references.citation: Br J Radiol. 2012 Apr;85(1012):390-4
references.pmid: 21304009
references.citation: BJU Int. 2003 Nov;92(7):685-9
references.pmid: 14616446
references.citation: Jpn J Clin Oncol. 2011 Oct;41(10):1209-13
references.pmid: 21862505
references.citation: Biometrics. 1983 Mar;39(1):207-15
references.pmid: 6871349
references.citation: Urol Int. 2006;76(3):209-12
references.pmid: 16601380
references.citation: ScientificWorldJournal. 2009 Oct 02;9:1040-5
references.pmid: 19802499
references.citation: Int Braz J Urol. 2010 Nov-Dec;36(6):685-91; discussion 691-2
references.pmid: 21176275