title: Unexplained Bone Pain Is an Independent Risk Factor for Bone Metastases in Newly Diagnosed Prostate Cancer: A Prospective Study.
abstract: OBJECTIVE
  To determine the relationship between bone pain and bone metastases in newly diagnosed prostate cancer.
  
  
  METHODS
  This prospective study of bone scintigraphy enrolled 567 consecutive patients with newly diagnosed prostate cancer. The presence of all-cause bone pain, known benign bone disease, and unexplained bone pain (ie, not related to known benign bone disease) was derived from a patient questionnaire. Univariate logistic regression models (LRMs) were used to assess the relationship between individual clinical variables (all-cause bone pain, unexplained bone pain, prostate-specific antigen, Gleason grade, T stage, and age) and bone metastases. A multivariate LRM was used to assess the relationship between bone metastases and all factors in combination. Agreement between the LRMs and bone metastases was estimated by accuracy and by Cohen's κ.
  
  
  RESULTS
  All-cause bone pain predicted bone metastasis in univariate but not multivariate analysis. Unexplained bone pain remained an independent predictor of bone metastases in multivariate analysis (odds ratio: 4.5; P < .001). Prostate-specific antigen was the single most important predictor of bone metastases (P < .001).
  
  
  CONCLUSIONS
  Unexplained bone pain was a strong independent risk factor for bone metastasis. Guidelines should recommend staging bone scintigraphy in patients with unexplained bone pain, regardless of other risk factors.
authors.affiliation: Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Physiology, Viborg Hospital, Viborg, Denmark. Electronic address: h.zacho@rn.dk.
authors.forename: Helle D
authors.initials: HD
authors.lastname: Zacho
authors.affiliation: Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Carsten D
authors.initials: CD
authors.lastname: Mørch
authors.affiliation: Department of Urology, Viborg Hospital, Viborg, Denmark.
authors.forename: Tamás
authors.initials: T
authors.lastname: Barsi
authors.affiliation: Department of Nuclear Medicine, Regional Hospital West Jutland, Herning, Denmark.
authors.forename: Jesper C
authors.initials: JC
authors.lastname: Mortensen
authors.affiliation: Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Physiology and Nuclear Medicine, Randers Hospital, Randers, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Bertelsen
authors.affiliation: Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Lars J
authors.initials: LJ
authors.lastname: Petersen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000150:complications / Q000175:diagnosis / Q000556:secondary*; D003718:Denmark / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000150:complications / Q000473:pathology*; D011877:Radionuclide Imaging; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed