Is there still a role for computed tomography and bone scintigraphy in prostate cancer staging? An analysis from the EUREKA-1 database.
OBJECTIVE
According to the current guidelines, computed tomography (CT) and bone scintigraphy (BS) are optional in intermediate-risk and recommended in high-risk prostate cancer (PCa). We wonder whether it is time for these examinations to be dismissed, evaluating their staging accuracy in a large cohort of radical prostatectomy (RP) patients.


METHODS
To evaluate the ability of CT to predict lymph node involvement (LNI), we included 1091 patients treated with RP and pelvic lymph node dissection, previously staged with abdomino-pelvic CT. As for bone metastases, we included 1145 PCa patients deemed fit for surgery, previously staged with Tc-99m methylene diphosphonate planar BS.


RESULTS
CT scan showed a sensitivity and specificity in predicting LNI of 8.8 and 98 %; subgroup analysis disclosed a significant association only for the high-risk subgroup of 334 patients (P 0.009) with a sensitivity of 11.8 % and positive predictive value (PPV) of 44.4 %. However, logistic multivariate regression analysis including preoperative risk factors excluded any additional predictive ability of CT even in the high-risk group (P 0.40). These data are confirmed by ROC curve analysis, showing a low AUC of 54 % for CT, compared with 69 % for Partin tables and 80 % for Briganti nomogram. BS showed some positivity in 74 cases, only four of whom progressed, while 49 patients with negative BS progressed during their follow-up, six of them immediately after surgery.


CONCLUSIONS
According to our opinion, the role of CT and BS should be restricted to selected high-risk patients, while clinical predictive nomograms should be adopted for the surgical planning.
Human Physiology Section, Neuroscience Department, University of Torino, Corso Raffaello 30, 10125, Turin, Italy. gabrielepda@alice.it.
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Gabriele
Urology Division, San Giovanni Bosco Hospital, Turin, Italy.
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Collura
Urology Division, Città della Salute e della Scienza Hospital, University of Torino, Turin, Italy.
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Oderda
Human Physiology Section, Neuroscience Department, University of Torino, Corso Raffaello 30, 10125, Turin, Italy.
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Stura
Urology Division, Città della Salute e della Scienza Hospital, University of Torino, Turin, Italy.
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Fiorito
Urology Division, San Luigi Gonzaga Hospital, University of Torino, Orbassano, Italy.
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Porpiglia
Urology Division, University of Eastern Piedmont, Novara, Italy.
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Terrone
Urology Division, University of Eastern Piedmont, Novara, Italy.
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M
Zacchero
Human Physiology Section, Neuroscience Department, University of Torino, Corso Raffaello 30, 10125, Turin, Italy.
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Guiot
Radiation Oncology Division, FPO-IRCCS Cancer Center of Candiolo, Candiolo, Italy.
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Gabriele
D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014055:Tomography, Emission-Computed / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
Accuracy; Bone scintigraphy; CT; Lymph node; Metastasis; Prostate cancer; Staging