Elsevier

Urology

Volume 61, Issue 3, March 2003, Pages 607-611
Urology

Adult urology: CME article
Limited value of bone scintigraphy and computed tomography in assessing biochemical failure after radical prostatectomy

https://doi.org/10.1016/S0090-4295(02)02411-1Get rights and content

Abstract

Objectives

To define the utility of bone scan and computed tomography (CT) in the evaluation of patients with biochemical recurrence after radical prostatectomy.

Methods

A retrospective analysis of the Center for Prostate Disease Research database was undertaken to identify patients who underwent radical prostatectomy between 1989 and 1998. Patients who developed biochemical recurrence (two prostate-specific antigen [PSA] levels greater than 0.2 ng/mL) and underwent either bone scan or CT within 3 years of this recurrence were selected for analysis. The preoperative clinical parameters, pathologic findings, serum PSA levels, follow-up data, and radiographic results were reviewed.

Results

One hundred thirty-two patients with biochemical recurrence and a bone scan or CT scan were identified. Of the 127 bone scans, 12 (9.4%) were positive. The patients with true-positive bone scans had an average PSA at the time of the bone scan of 61.3 ± 71.2 ng/mL (range 1.3 to 123). Their PSA velocities, calculated from the PSA levels determined immediately before the radiographic studies, averaged 22.1 ± 24.7 ng/mL/mo (range 0.14 to 60.0). Only 2 patients with a positive bone scan had a PSA velocity of less than 0.5 ng/mL/mo. Of the 86 CT scans, 12 (14.0%) were positive. On logistic regression analysis, PSA and PSA velocity predicted the bone scan result (P <0.001 each) and PSA velocity predicted the CT scan result (P = 0.047).

Conclusions

Patients with biochemical recurrence after radical prostatectomy have a low probability of a positive bone scan (9.4%) or a positive CT scan (14.0%) within 3 years of biochemical recurrence. Most patients with a positive bone scan have a high PSA level and a high PSA velocity (greater than 0.5 ng/mL/mo).

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.

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