Background: To evaluate the factors associated with positive bone scans after biochemical recurrence (BCR) following radical prostatectomy in both hormone-naive subjects and subjects after androgen-deprivation therapy (ADT).
Methods: Retrospective analysis of 380 bone scans of 301 hormone-naive subjects and 214 bone scans of 137 subjects after ADT following BCR from the Shared Equal Access Regional Cancer Hospital database. Generalized estimating equations and local regression plots were used to evaluate bone scan positivity by patients' demographics, pathological features, PSA levels and kinetics.
Results: Among hormone-naive subjects and subjects on ADT, bone scan positivity was seen in 24 (6%) and 65 (30%) subjects, respectively. In hormone-naive subjects, the higher prescan PSA, higher PSA velocity (PSAV) and shorter PSA doubling time (PSADT) were significantly associated with positive scans (P=0.008, P< 0.001 and P< 0.001, respectively). In subjects after ADT, the prescan PSA, PSAV and PSADT were significantly associated with positive scans (P=0.011, P< 0.001 and P=0.002, respectively). Regression plots showed increased scan positivity with increasing PSA levels and shortening PSADT (all P< 0.001) for both hormone-naive subjects and subjects after ADT. For a given PSA level and PSADT, subjects on ADT had higher bone scan positivity.
Conclusions: In both hormone-naive subjects and subjects after ADT, more aggressive and advanced disease identified by higher PSA levels, higher PSAV and shorter PSADT were associated with higher bone scan positivity. For the same PSA level and PSADT, subjects after ADT had higher bone scan positivity than hormone-naive subjects. Therefore, PSA levels and kinetics may be used as selection criteria for bone scan in these patients.
Written by:
Moreira DM, Cooperberg MR, Howard LE, Aronson WJ, Kane CJ, Terris MK, Amling CL, Kuchibhatla M, Freedland SJ. Are you the author?
The Arthur Smith Institute for Urology, North Shore Long Island Jewish Health System, New Hyde Park, NY, USA; Departments of Urology, and Epidemiology and Biostatistics, University of California, San Francisco and Urology Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA; Urology Section, Veterans Affairs Medical Center, Durham, NC, USA; Urology Section, Department of Surgery, Veterans Affairs Medical Center, Los Angeles, CA, USA; Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA, USA; Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, CA, USA; Urology Section, Division of Surgery, Veterans Affairs Medical Centers; Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA, USA; Division of Urology, Department of Surgery, Oregon Health and Science University, Portland, OR, USA; Division of Urology, Department of Surgery, and the Duke Prostate Center, Duke University School of Medicine, Durham, NC, USA; Department of Pathology, Duke University School of Medicine, Durham, NC, USA.
Reference: Prostate Cancer Prostatic Dis. 2014 Jan 14. Epub ahead of print.
doi: 10.1038/pcan.2013.59
PubMed Abstract
PMID: 24418913
UroToday.com Bone Metastases Section
