Establishing the pathways and indications for performing isotope bone scans in newly diagnosed intermediate‐risk localised prostate cancer – results from a large contemporaneous cohort

• Published in: BJU international 2017-11, Vol.120 (5B), p.E59-E63
• Main Authors: KandaSwamy, Gokul V., Bennett, Adam, Narahari, Krishna, Hughes, Owen, Rees, John, Kynaston, Howard
• Format: Article
• Language: English
• Subjects: Biomarkers, Tumor; Bone and Bones - diagnostic imaging; Bone and Bones - pathology; Bone cancer; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - secondary; bony metastasis; Cohort Studies; Computed tomography; Europe; Gleason grade grouping; Guideline Adherence - statistics & numerical data; Humans; Magnetic resonance imaging; Male; Metastases; Neoplasm Grading; new prostate cancer diagnosis; Pelvis; Practice Guidelines as Topic; Predictive Value of Tests; Prostate cancer; prostate cancer guidelines; Prostate-specific antigen; Prostate-Specific Antigen - blood; ProstateCancer; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Radionuclide Imaging; Risk groups; staging bone scan; United Kingdom
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.13850

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