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- Title
Establishing the pathways and indications for performing isotope bone scans in newly diagnosed intermediate-risk localised prostate cancer - results from a large contemporaneous cohort.
- Authors
KandaSwamy, Gokul V.; Bennett, Adam; Narahari, Krishna; Hughes, Owen; Rees, John; Kynaston, Howard
- Abstract
Objective To establish the pattern of isotope bone scan ( BS) positivity in a large contemporaneous cohort of patients with newly diagnosed localised prostate cancer and compare with the European Association of Urology ( EAU) guidelines, as imaging guidelines and clinical practice for using BS to stage newly diagnosed patients with intermediate-risk localised prostate cancer are not uniform in the literature. Patients and Methods All patients with newly diagnosed prostate cancer were discussed in a specialist multidisciplinary team meeting and were prospectively entered in a database. Patients were categorised based on D'Amico classification. All intermediate- and high-risk patients had pelvic magnetic resonance imaging and BS unless contraindicated. The BS positivity in each group was analysed and the negative predictive value ( NPV) calculated. A cohort of 2720 patients between 2002 and 2015 was retrospectively analysed. Results Of 976 patients in the D'Amico intermediate-risk category, 99 had primary Gleason pattern 4. Only one of the 99 patients had a positive BS and there were no positive BS in patients with Gleason primary pattern 3 in the intermediate-risk category. On subgroup analysis, based on prostate-specific antigen ( PSA) level and Gleason grade alone, the BS-positivity rate in patients with a PSA level of <20 ng/ mL and Gleason primary pattern 4 vs 3 was 6% and 0%, respectively, resulting in 100% NPV for a positive BS with Gleason primary pattern 3 and a PSA level of <20 ng/ mL. The importance of clinical T stage ( cT) was also noted, as eight of 146 patients had positive BS, who were high risk on cT stage, with a PSA level of <20 ng/ mL and Gleason score <8. All eight patients had Gleason primary pattern 4. By limiting BS to the population at risk (all high-risk + intermediate-risk with primary pattern 4), 68 BS per year could have been avoided in a single centre. A limitation was that there was no histological confirmation of bony metastases. Extending the BS recommendation considering the new Gleason Grade Grouping is discussed. Conclusion This study confirms that a staging BS can be safely avoided in patients with intermediate-risk prostate cancer with Gleason primary pattern 3 and to limit performing BS in all high-risk prostate cancer and in the intermediate-risk group when the primary Gleason pattern is 4, thereby reinforcing the current recommendations of the EAU guidelines.
- Subjects
PROSTATE cancer; DIAGNOSIS; ANALYSIS of bones; BONE metastasis; GLEASON grading system; PROSTATE cancer risk factors
- Publication
BJU International, 2017, Vol 120, Issue 5B, pE59
- ISSN
1464-4096
- Publication type
Article
- DOI
10.1111/bju.13850