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Predicting Radionuclide Bone Scan Findings in Patients with Newly Diagnosed, Untreated Prostate Cancer: Prostate Specific Antigen is Superior to All Other Clinical Parameters

1991; Lippincott Williams & Wilkins; Volume: 145; Issue: 2 Linguagem: Inglês

10.1016/s0022-5347(17)38325-8

1527-3792

Frank M. Chybowski, Jeffrey J. Larson Keller, Erik J. Bergstralh, Joseph E. Oesterling,

Medical Imaging and Pathology Studies

No AccessJournal of Urology1 Feb 1991Predicting Radionuclide Bone Scan Findings in Patients with Newly Diagnosed, Untreated Prostate Cancer: Prostate Specific Antigen is Superior to All Other Clinical Parameters Frank M. Chybowski, Jeffrey J. Larson Keller, Erik J. Bergstralh, and Joseph E. Oesterling Frank M. ChybowskiFrank M. Chybowski , Jeffrey J. Larson KellerJeffrey J. Larson Keller , Erik J. BergstralhErik J. Bergstralh , and Joseph E. OesterlingJoseph E. Oesterling View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)38325-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Presently, the standard staging evaluation of prostate cancer includes digital rectal examination, measurement of serum tumor markers and a radionuclide bone scan. To evaluate the ability of local clinical stage, tumor grade, serum acid phosphatase, serum prostatic acid phosphatase (PAP) and serum prostate specific antigen (PSA) to predict bone scan findings, a retrospective review of 521 randomly chosen patients (mean age 70 years, range 44 to 92 years) with newly diagnosed, untreated prostate cancer was performed. Local clinical stage, tumor grade, acid phosphatase, PAP and PSA all correlated positively with bone scan findings (p <0.0001). Using receiver operating characteristic curves, however, PSA had the best over-all correlation with bone scan results. The median serum PSA concentration in patients with a positive bone scan was 158.0ng./ml., whereas men with a negative bone scan had a median serum PSA level of 11.3ng./ml. (p <0.0001). Using multivariate logistic regression analysis, local clinical stage, tumor grade, acid phosphatase and PAP were evaluated in combination with PSA to assess whether these parameter increased the ability of PSA alone to predict bone scan findings. None of these clinical parameters, irrespective of the combination used, contributed appreciably to the predictive power of PSA alone. A probability plot with 95% confidence intervals was constructed that allows the practicing urologist to estimate on an individual basis the probability of a positive bone scan for any given serum PSA value. The most significant finding of this study, however, was the negative predictive value of a low serum PSA concentration for bone scan finding. In 306 men with a serum PSA level of 20ng./ml. or less only 1 (PSA 18.2ng./ml.) had a positive bone scan (negative predictive value 99.7%). This finding would suggest that a staging radionuclide bone scan in a previously untreated prostate cancer patient with a low serum PSA concentration may not be necessary. © 1991 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySobol I, Zaid H, Haloi R, Mynderse L, Froemming A, Lowe V, Davis B, Kwon E and Karnes R (2018) Contemporary Mapping of Post-Prostatectomy Prostate Cancer Relapse with 11C-Choline Positron Emission Tomography and Multiparametric Magnetic Resonance ImagingJournal of Urology, VOL. 197, NO. 1, (129-134), Online publication date: 1-Jan-2017.Makarov D, Desai R, Yu J, Sharma R, Abraham N, Albertsen P, Penson D and Gross C (2018) The Population Level Prevalence and Correlates of Appropriate and Inappropriate Imaging to Stage Incident Prostate Cancer in the Medicare PopulationJournal of Urology, VOL. 187, NO. 1, (97-102), Online publication date: 1-Jan-2012.Choi W, Williams S, Gu X, Lipsitz S, Nguyen P and Hu J 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Volume 145Issue 2February 1991Page: 313-318 Advertisement Copyright & Permissions© 1991 by The American Urological Association Education and Research, Inc.Keywordsradionuclide imagingprostatic neoplasmsneoplasmadenocarcinomaantigensprostateMetricsAuthor Information Frank M. Chybowski More articles by this author Jeffrey J. Larson Keller More articles by this author Erik J. Bergstralh More articles by this author Joseph E. Oesterling More articles by this author Expand All Advertisement PDF downloadLoading ...