Lin K, Szabo Z, Chin B B, Civelek A C
Division of Nuclear Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Clin Nucl Med. 1999 Aug;24(8):579-82. doi: 10.1097/00003072-199908000-00007.
This study evaluated the role of bone scans in managing newly diagnosed, untreated prostate cancer.
Two hundred seventy consecutive staging bone scans in patients (mean age, 69 years) with newly diagnosed prostate cancer who had serum prostate-specific antigen (PSA) determinations and biopsies between January 1995 and October 1997 were evaluated retrospectively.
The bone scans were positive for metastatic bone disease in 24 patients and negative in 246. Serum PSA levels, the number of positive biopsy cores, the extent of tumor in the prostate gland, and Gleason scores were all significantly correlated with scintigraphic bone metastases (P < 0.0001 for each). Of the 177 patients with PSA levels less than 10 ng/ml, three had bone metastases. Bone metastases were found in 2 of 34 patients with PSA levels of 10.1 to 20 ng/ml, in 3 of 29 patients with PSA values of 20.1 to 50 ng/ml, and in 16 of 30 patients with PSA levels greater than 50.1 ng/ml. Only one patient had a bone metastasis when the prostate cancer involved fewer than 2 biopsy cores (1 of 135) or when disease was confined to one lobe (1 of 131), but the incidence increased significantly when the malignancy involved three or more biopsy cores (20 of 114) or disease was present in both prostate lobes (20 of 118). Four of 160 patients with Gleason scores less than 6 had bone metastases, whereas 20 of 110 patients with Gleason scores greater than 7 had bone metastases.
The likelihood of bone metastases is low in patients with newly diagnosed, untreated prostate cancer when the initial PSA level was less than 10 ng/ml, the number of positive biopsy cores was less than 2, tumor was confined to one lobe, or the Gleason score was less than 6. However, none of these criteria can be used to exclude metastatic bone disease. A baseline bone scan is an important staging procedure and should be obtained to provide maximum data for clinical management of the disease.
本研究评估了骨扫描在初诊、未经治疗的前列腺癌管理中的作用。
回顾性评估了1995年1月至1997年10月期间270例连续进行分期骨扫描的患者（平均年龄69岁），这些患者均为初诊前列腺癌，且进行了血清前列腺特异性抗原（PSA）检测和活检。
24例患者的骨扫描显示有骨转移，246例为阴性。血清PSA水平、阳性活检核心数量、前列腺内肿瘤范围和Gleason评分均与骨扫描转移显著相关（每项P<0.0001）。在177例PSA水平低于10 ng/ml的患者中，3例有骨转移。PSA水平为10.1至20 ng/ml的34例患者中有2例发现骨转移，PSA值为20.1至50 ng/ml的29例患者中有3例，PSA水平高于50.1 ng/ml的30例患者中有16例。当前列腺癌累及少于2个活检核心（135例中的1例）或疾病局限于一个叶（131例中的1例）时，只有1例患者有骨转移，但当恶性肿瘤累及3个或更多活检核心（114例中的20例）或两个前列腺叶均有疾病（118例中的20例）时，发生率显著增加。Gleason评分低于6分的160例患者中有4例有骨转移，而Gleason评分高于7分的110例患者中有20例有骨转移。
初诊、未经治疗的前列腺癌患者，若初始PSA水平低于10 ng/ml、阳性活检核心数量少于2个、肿瘤局限于一个叶或Gleason评分低于6分，则发生骨转移的可能性较低。然而，这些标准均不能用于排除骨转移疾病。基线骨扫描是一项重要的分期检查，应进行以提供该疾病临床管理的最大数据。
