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Radionuclide bone scintigraphy in patients with biochemical recurrence after radical prostatectomy: when is it indicated?

OBJECTIVE To evaluate the use of radionuclide bone scintigraphy following biochemical recurrence after radical retropubic prostatectomy (RRP) for localized prostate cancer. PATIENTS AND METHODS Of 1197 patients undergoing RRP we identified those with biochemical recurrence and who had also had a bon...

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Published in:BJU international 2004-08, Vol.94 (3), p.299-302
Main Authors: Gomez, Pablo, Manoharan, Marugesan, Kim, Sandy S., Soloway, Mark S.
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description OBJECTIVE To evaluate the use of radionuclide bone scintigraphy following biochemical recurrence after radical retropubic prostatectomy (RRP) for localized prostate cancer. PATIENTS AND METHODS Of 1197 patients undergoing RRP we identified those with biochemical recurrence and who had also had a bone scan. Biochemical recurrence was defined as a prostate specific antigen (PSA) level of ≥ 0.4 ng/mL. Patients with indeterminate bone scan findings and those in whom the interval between the PSA test and the bone scan was >3 months were excluded. Patient age, PSA level and other relevant pathological details were recorded. Clinical symptoms at the time of bone scan, androgen deprivation after RRP, bone scintigram details and time to recurrence were documented. RESULTS Of the 1197 patients, 153 (12.8%) had a biochemical recurrence and 35 (23%) of these had a total of 44 bone scans taken over a mean (sd) follow‐up of 70.4 (35.6) months; 34 (77%) bone scans were negative (group 1) and 10 (33%) positive (group 2). In group 1 the mean PSA at the bone scan was 5.2 ng/mL; 76% of the patients had a PSA of 7 ng/mL. The only significant difference between the groups was the PSA at the time of the bone scan (P 
doi_str_mv 10.1111/j.1464-410X.2004.04927.x
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PATIENTS AND METHODS Of 1197 patients undergoing RRP we identified those with biochemical recurrence and who had also had a bone scan. Biochemical recurrence was defined as a prostate specific antigen (PSA) level of ≥ 0.4 ng/mL. Patients with indeterminate bone scan findings and those in whom the interval between the PSA test and the bone scan was &gt;3 months were excluded. Patient age, PSA level and other relevant pathological details were recorded. Clinical symptoms at the time of bone scan, androgen deprivation after RRP, bone scintigram details and time to recurrence were documented. RESULTS Of the 1197 patients, 153 (12.8%) had a biochemical recurrence and 35 (23%) of these had a total of 44 bone scans taken over a mean (sd) follow‐up of 70.4 (35.6) months; 34 (77%) bone scans were negative (group 1) and 10 (33%) positive (group 2). In group 1 the mean PSA at the bone scan was 5.2 ng/mL; 76% of the patients had a PSA of &lt;7 ng/mL. In group 2 the mean PSA at the bone scan was 30.7 ng/mL and all patients had a PSA of &gt;7 ng/mL. The only significant difference between the groups was the PSA at the time of the bone scan (P &lt; 0.001). CONCLUSION Bone scintigraphy is a sensitive diagnostic tool for detecting prostate cancer metastases to bone. A bone scan in patients with a serum PSA of &lt;7 ng/mL on biochemical recurrence after RRP is unlikely to be positive, whereas a PSA of ≥ 20 ng/mL is. The presence of skeletal symptoms or a PSA level of &gt;7 ng/mL should prompt the clinician to obtain a bone scintigram.</description><identifier>ISSN: 1464-4096</identifier><identifier>EISSN: 1464-410X</identifier><identifier>DOI: 10.1111/j.1464-410X.2004.04927.x</identifier><identifier>PMID: 15291855</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Ltd</publisher><subject>Aged ; biochemical recurrence ; Biological and medical sciences ; Bone Neoplasms - blood ; Bone Neoplasms - diagnostic imaging ; Bone Neoplasms - secondary ; bone scan ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Neoplasm Recurrence, Local ; Nephrology. Urinary tract diseases ; Osteoarticular system. Muscles ; Postoperative Care - methods ; Prognosis ; prostate carcinoma ; Prostate-Specific Antigen - blood ; Prostatectomy ; Prostatic Neoplasms - blood ; Prostatic Neoplasms - surgery ; radical prostatectomy ; Radionuclide Imaging ; Radionuclide investigations ; Retrospective Studies ; Tumors of the urinary system ; Urinary tract. Prostate gland</subject><ispartof>BJU international, 2004-08, Vol.94 (3), p.299-302</ispartof><rights>2004 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3957-a1d3979719ff0b5bce149302dff0819a7c90354711e73c07cc98c7724b9bd0a3</citedby><cites>FETCH-LOGICAL-c3957-a1d3979719ff0b5bce149302dff0819a7c90354711e73c07cc98c7724b9bd0a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=15994392$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15291855$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gomez, Pablo</creatorcontrib><creatorcontrib>Manoharan, Marugesan</creatorcontrib><creatorcontrib>Kim, Sandy S.</creatorcontrib><creatorcontrib>Soloway, Mark S.</creatorcontrib><title>Radionuclide bone scintigraphy in patients with biochemical recurrence after radical prostatectomy: when is it indicated?</title><title>BJU international</title><addtitle>BJU Int</addtitle><description>OBJECTIVE To evaluate the use of radionuclide bone scintigraphy following biochemical recurrence after radical retropubic prostatectomy (RRP) for localized prostate cancer. PATIENTS AND METHODS Of 1197 patients undergoing RRP we identified those with biochemical recurrence and who had also had a bone scan. Biochemical recurrence was defined as a prostate specific antigen (PSA) level of ≥ 0.4 ng/mL. Patients with indeterminate bone scan findings and those in whom the interval between the PSA test and the bone scan was &gt;3 months were excluded. Patient age, PSA level and other relevant pathological details were recorded. Clinical symptoms at the time of bone scan, androgen deprivation after RRP, bone scintigram details and time to recurrence were documented. RESULTS Of the 1197 patients, 153 (12.8%) had a biochemical recurrence and 35 (23%) of these had a total of 44 bone scans taken over a mean (sd) follow‐up of 70.4 (35.6) months; 34 (77%) bone scans were negative (group 1) and 10 (33%) positive (group 2). In group 1 the mean PSA at the bone scan was 5.2 ng/mL; 76% of the patients had a PSA of &lt;7 ng/mL. In group 2 the mean PSA at the bone scan was 30.7 ng/mL and all patients had a PSA of &gt;7 ng/mL. The only significant difference between the groups was the PSA at the time of the bone scan (P &lt; 0.001). CONCLUSION Bone scintigraphy is a sensitive diagnostic tool for detecting prostate cancer metastases to bone. A bone scan in patients with a serum PSA of &lt;7 ng/mL on biochemical recurrence after RRP is unlikely to be positive, whereas a PSA of ≥ 20 ng/mL is. The presence of skeletal symptoms or a PSA level of &gt;7 ng/mL should prompt the clinician to obtain a bone scintigram.</description><subject>Aged</subject><subject>biochemical recurrence</subject><subject>Biological and medical sciences</subject><subject>Bone Neoplasms - blood</subject><subject>Bone Neoplasms - diagnostic imaging</subject><subject>Bone Neoplasms - secondary</subject><subject>bone scan</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Osteoarticular system. Muscles</subject><subject>Postoperative Care - methods</subject><subject>Prognosis</subject><subject>prostate carcinoma</subject><subject>Prostate-Specific Antigen - blood</subject><subject>Prostatectomy</subject><subject>Prostatic Neoplasms - blood</subject><subject>Prostatic Neoplasms - surgery</subject><subject>radical prostatectomy</subject><subject>Radionuclide Imaging</subject><subject>Radionuclide investigations</subject><subject>Retrospective Studies</subject><subject>Tumors of the urinary system</subject><subject>Urinary tract. Prostate gland</subject><issn>1464-4096</issn><issn>1464-410X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><recordid>eNqNkMFO3DAQQC1UVCjtLyBf6G1TO3HiNVJVASqUCgkJUak3y5lMul4lztZ2tOTvcbpb6LH2wWPPm_HoEUI5y3han9YZF5VYCM5-ZjljImNC5TJ7OiDHL4k3f2OmqiPyLoQ1Y-mhKt-SI17mii_L8phMD6axgxuhsw3SenBIA1gX7S9vNquJWkc3Jlp0MdCtjSta2wFW2FswHfUIo_foAKlpI3rqU7M5sfFDiCYixKGfzul2hY7aQG1M_WYiYvPlPTlsTRfww_48IY_XXx-vvi3u7m9ury7uFlCoUi4MbwolleSqbVld1oBcqILlTbouuTISFCtKITlHWQCTAGoJUuaiVnXDTHFCPu7appl-jxii7m0A7DrjcBiDriqZtuIJXO5ASMMHj63eeNsbP2nO9Gxdr_UsVM9y9Wxd_7Gun1Lp6f6Pse6xeS3ca07A2R4wIflpvXFgwz-cUqJQeeI-77it7XD67wH05fcfc1Q8A1nVoCY</recordid><startdate>200408</startdate><enddate>200408</enddate><creator>Gomez, Pablo</creator><creator>Manoharan, Marugesan</creator><creator>Kim, Sandy S.</creator><creator>Soloway, Mark S.</creator><general>Blackwell Science Ltd</general><general>Blackwell</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200408</creationdate><title>Radionuclide bone scintigraphy in patients with biochemical recurrence after radical prostatectomy: when is it indicated?</title><author>Gomez, Pablo ; Manoharan, Marugesan ; Kim, Sandy S. ; Soloway, Mark S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3957-a1d3979719ff0b5bce149302dff0819a7c90354711e73c07cc98c7724b9bd0a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Aged</topic><topic>biochemical recurrence</topic><topic>Biological and medical sciences</topic><topic>Bone Neoplasms - blood</topic><topic>Bone Neoplasms - diagnostic imaging</topic><topic>Bone Neoplasms - secondary</topic><topic>bone scan</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Osteoarticular system. Muscles</topic><topic>Postoperative Care - methods</topic><topic>Prognosis</topic><topic>prostate carcinoma</topic><topic>Prostate-Specific Antigen - blood</topic><topic>Prostatectomy</topic><topic>Prostatic Neoplasms - blood</topic><topic>Prostatic Neoplasms - surgery</topic><topic>radical prostatectomy</topic><topic>Radionuclide Imaging</topic><topic>Radionuclide investigations</topic><topic>Retrospective Studies</topic><topic>Tumors of the urinary system</topic><topic>Urinary tract. Prostate gland</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gomez, Pablo</creatorcontrib><creatorcontrib>Manoharan, Marugesan</creatorcontrib><creatorcontrib>Kim, Sandy S.</creatorcontrib><creatorcontrib>Soloway, Mark S.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>BJU international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gomez, Pablo</au><au>Manoharan, Marugesan</au><au>Kim, Sandy S.</au><au>Soloway, Mark S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Radionuclide bone scintigraphy in patients with biochemical recurrence after radical prostatectomy: when is it indicated?</atitle><jtitle>BJU international</jtitle><addtitle>BJU Int</addtitle><date>2004-08</date><risdate>2004</risdate><volume>94</volume><issue>3</issue><spage>299</spage><epage>302</epage><pages>299-302</pages><issn>1464-4096</issn><eissn>1464-410X</eissn><abstract>OBJECTIVE To evaluate the use of radionuclide bone scintigraphy following biochemical recurrence after radical retropubic prostatectomy (RRP) for localized prostate cancer. PATIENTS AND METHODS Of 1197 patients undergoing RRP we identified those with biochemical recurrence and who had also had a bone scan. Biochemical recurrence was defined as a prostate specific antigen (PSA) level of ≥ 0.4 ng/mL. Patients with indeterminate bone scan findings and those in whom the interval between the PSA test and the bone scan was &gt;3 months were excluded. Patient age, PSA level and other relevant pathological details were recorded. Clinical symptoms at the time of bone scan, androgen deprivation after RRP, bone scintigram details and time to recurrence were documented. RESULTS Of the 1197 patients, 153 (12.8%) had a biochemical recurrence and 35 (23%) of these had a total of 44 bone scans taken over a mean (sd) follow‐up of 70.4 (35.6) months; 34 (77%) bone scans were negative (group 1) and 10 (33%) positive (group 2). In group 1 the mean PSA at the bone scan was 5.2 ng/mL; 76% of the patients had a PSA of &lt;7 ng/mL. In group 2 the mean PSA at the bone scan was 30.7 ng/mL and all patients had a PSA of &gt;7 ng/mL. The only significant difference between the groups was the PSA at the time of the bone scan (P &lt; 0.001). CONCLUSION Bone scintigraphy is a sensitive diagnostic tool for detecting prostate cancer metastases to bone. A bone scan in patients with a serum PSA of &lt;7 ng/mL on biochemical recurrence after RRP is unlikely to be positive, whereas a PSA of ≥ 20 ng/mL is. The presence of skeletal symptoms or a PSA level of &gt;7 ng/mL should prompt the clinician to obtain a bone scintigram.</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Ltd</pub><pmid>15291855</pmid><doi>10.1111/j.1464-410X.2004.04927.x</doi><tpages>4</tpages></addata></record>
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language eng
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subjects Aged
biochemical recurrence
Biological and medical sciences
Bone Neoplasms - blood
Bone Neoplasms - diagnostic imaging
Bone Neoplasms - secondary
bone scan
Humans
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical sciences
Middle Aged
Neoplasm Recurrence, Local
Nephrology. Urinary tract diseases
Osteoarticular system. Muscles
Postoperative Care - methods
Prognosis
prostate carcinoma
Prostate-Specific Antigen - blood
Prostatectomy
Prostatic Neoplasms - blood
Prostatic Neoplasms - surgery
radical prostatectomy
Radionuclide Imaging
Radionuclide investigations
Retrospective Studies
Tumors of the urinary system
Urinary tract. Prostate gland
title Radionuclide bone scintigraphy in patients with biochemical recurrence after radical prostatectomy: when is it indicated?
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