Adult urology: CME articleLimited value of bone scintigraphy and computed tomography in assessing biochemical failure after radical prostatectomy☆
Section snippets
Material and methods
An analysis of the Center for Prostate Disease Research multicenter prostate cancer database15 was carried out to identify patients who had undergone RP for clinically localized (cT1-3N0M0) prostate cancer between 1989 and 1998 at four participating medical centers (Naval Medical Center San Diego, Walter Reed Army Medical Center, Madigan Army Medical Center, and Brooke Army Medical Center). Patients with biochemical recurrence were the focus of this study. Biochemical recurrence was defined as
Results
One hundred thirty-four patients with biochemical recurrence after RP were identified who had received a bone scan or CT scan within 3 years of the date of biochemical recurrence. The dates of surgery ranged between 1988 and 1998. Of 127 bone scans, 12 (9.5%) were positive. Ten were suspicious, but plain radiography or magnetic resonance imaging found no evidence of metastatic disease. The patients with positive bone scans had significantly greater PSA levels and greater PSA velocities than
Comment
The evaluation of patients with biochemical failure after RP is a challenge. Terris et al.19 in 1991 recommended that bone scans be routinely obtained in patients with detectable PSA levels after RP. In their 21 patients with a rising PSA after RP, 10 had positive or indeterminate studies (48%). However, of those patients with a positive bone scan, 7 of 10 had positive lymph node metastasis at the time of RP. Partin et al.12 evaluated 51 men with PSA-only recurrence after RP who were followed
Conclusions
Patients with biochemical recurrence after RP have a low probability of having a positive bone scan (9.4%) or new information demonstrated on CT scan (9.3%) within 3 years of biochemical recurrence. If the serum PSA level at the recurrence evaluation was less than 10 ng/mL, only 4.5% of our patients had a positive bone scan (3 of 67). Most patients with a positive bone scan have a high PSA level and a high PSA velocity (greater than 0.5 ng/mL/mo). Thus, radiographic assessment with bone scan
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This work was supported by a grant from the Center for Prostate Disease Research, a program of the Henry M. Jackson Foundation for the Advancement of Military Medicine (Rockville, Maryland), funded by the U.S. Army Medical Research and Materiel Command.
The opinions and assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the U.S. Army, U.S. Navy, the Department of Defense, or the U.S. Government.