title: Imaging yield from 133 consecutive patients with prostate cancer and low trigger PSA from a single institution.
abstract: OBJECTIVE
  To investigate the yield of imaging in patients with relapsed prostate cancer (PC) with a low trigger prostate-specific antigen (PSA).
  
  
  METHODS
  This institutional review board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study included all 133 patients (mean age 68 years; range 45-88; median 69 months since original diagnosis; interquartile range [IQR]: 32-139) with hormone-sensitive PC (HSPC, n=28) or castration-resistant PC (CRPC, n=105) and trigger PSA <4 ng/ml, who underwent same-day bone scintigraphy and computed tomography (CT; total 224 time points) at Dana-Farber Cancer Institute from January to December 2013. Clinical and pathological data were obtained by manual review of the electronic medical records. All the included bone scintigraphs and CT images were reviewed by a fellowship-trained oncoradiologist to record the metastatic pattern and any clinically significant non-metastatic findings.
  
  
  RESULTS
  Ninety-four of the 133 (71%) patients had metastatic disease (18/28 [64%] with HSPC, 76/105 [72%] with CRPC). Forty-one of the 133 (31%) patients developed new metastatic disease and 23/133 (17%) developed new clinically significant non-metastatic findings. The incidence of osseous, nodal, and visceral metastases, and clinically significant non-metastatic findings was similar across the HSPC and CRPC groups (p>0.05 for all). Fifty-seven of the 133 (43%) patients had findings seen only at CT, of which 37 had new extra-osseous findings. Only 2/133 (2%) had findings at bone scintigraphy not seen at CT, both in areas not covered on CT.
  
  
  CONCLUSIONS
  Imaging frequently demonstrated new metastatic and non-metastatic findings in patients with a low trigger PSA. CT is valuable in these patients because extra-osseous findings not visible at bone scintigraphy are frequently seen.
authors.affiliation: Department of Radiology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: ashinagare@partners.org.
authors.forename: A B
authors.initials: AB
authors.lastname: Shinagare
authors.affiliation: Department of Radiology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Keraliya
authors.affiliation: Department of Radiology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Somarouthu
authors.affiliation: Department of Radiology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: S H
authors.initials: SH
authors.lastname: Tirumani
authors.affiliation: Department of Radiology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: N H
authors.initials: NH
authors.lastname: Ramaiya
authors.affiliation: Harvard Medical School, Boston, MA, USA; Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: P W
authors.initials: PW
authors.lastname: Kantoff
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D064129:Prostatic Neoplasms, Castration-Resistant / Q000000981:diagnostic imaging / Q000473:pathology; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen