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Published on: October 10, 2019
Prospective multicenter study of bone scintigraphy in consecutive patients with newly diagnosed prostate cancer
Helle Damgaard Zacho1, Tamás Barsi, Jesper C Mortensen
1From the *Department of Clinical Physiology, Viborg Hospital, Viborg; †Department of Nuclear Medicine, Aalborg University Hospital, Aalborg; ‡Department of Urology, Viborg Hospital, Viborg; Departments of §Nuclear Medicine and ∥Urology, Regional Hospital West Jutland, Herning; Departments of ¶Clinical Physiology and Nuclear Medicine and #Urology, Randers Hospital, Randers; and **Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Background:
International guidelines uniformly suggest no routine staging of bone metastasis in patients with bone scintigraphy (BS) in low-risk prostate cancer (PCa). These recommendations are based on retrospective investigations only. In addition, BS has most often been reported as a definitive investigation with no room for equivocal cases.
Objective:
The objective of this study was to determine the diagnostic value of BS in a large cohort of consecutive patients with newly diagnosed PCa.
Design, Setting, And Participants:
Over a period of 1.5 years in 2008 to 2009, consecutive patients with newly diagnosed PCa were enrolled in a noninterventional, multicenter, observational study. All patients had a whole-body, planar BS. Clinical history and clinical, pathological, and biochemical data were obtained from electronic patient files and questionnaires.
Outcome Measurements And Statistical Analysis:
Bone scintigraphy was classified into 4 categories as nonmalignant, equivocal, likely malignant, or multiple metastasis. The primary end point was final imaging, which was a composite end point of BS and additional CT and MRI investigations.
Results And Limitations:
A total of 635 eligible patients were recruited. Their median prostate-specific antigen (PSA) was 15 ng/mL, median Gleason was 7, and 80% of patients had local disease (T1 or T2). The proportion of nonmalignant BS was 61%, equivocal scans 26%, and likely or definitive metastasis 13%. A total of 154 patients had additional CT or MRI investigations. The final imaging diagnosis showed a prevalence of bone metastases in 87 (13.7%) of 635 patients. No bone metastases were observed in (1) patients with PSA of less than 10 ng/mL, independently of the clinical Tstage and Gleason score (n = 212) and (2) PSA of less than 20 ng/mL if Tstage is less than T3 and Gleason score is less than 8 (n = 97). Approximately 50% of the patients enrolled in this study met these criteria.
Conclusion:
This is the first prospective trial to demonstrate that BS can be avoided in patients with low-risk PCa.
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