O'Sullivan J M, Norman A R, Cook G J, Fisher C, Dearnaley D P
Academic Unit of Radiotherapy and Clinical Oncology, Institute of Cancer Research/Royal Marsden Hospital, Sutton, Surrey, UK.
BJU Int. 2003 Nov;92(7):685-9. doi: 10.1046/j.1464-410x.2003.04480.x.
To determine if it is possible to exclude staging bone scans in a greater proportion of patients if more consideration is given to T stage and Gleason score, as recent guidelines from the National Institute of Clinical Excellence state that routine staging bone scans for prostate cancer are unnecessary in patients with a prostate specific antigen level (PSA) of < 10 ng/mL and Gleason scores of < 8.
We identified a cohort of consecutive patients with untreated prostate cancer who had a staging isotope bone scan between 1 January 1995 and 31 December 2000, who were not on hormone therapy, who had their PSA estimated within 30 days of the scan, and who had histologically confirmed prostate cancer on biopsy reviewed at the Royal Marsden. Data were analysed according to Gleason score, major Gleason grade, clinical T-stage and PSA level.
In all, 420 patients were identified who fulfilled the criteria for inclusion; 67 scans (16%, 95% confidence interval, CI, 13-20%) were positive. Of the 187 scans taken in patients with a PSA level of <or= 20 ng/mL, stage < T4 and Gleason < 8 (with major Gleason grade < 4), two (1%, 0.3-4%) were reported as positive, giving a negative predictive value of 99% (95% CI 98.5-99.5%) for these criteria for avoiding the need for staging bone scans. In 116 patients (28%) with Gleason score 7, of whom 28 (24%) had positive scans, there was a statistically significant association between positive scans and a major Gleason pattern of 4 compared with 3.
Isotope bone scans are an unnecessary part of staging of prostate cancer if the PSA level is <or= 20 ng/mL, stage < T4 and Gleason score < 8, and should be omitted unless the major Gleason pattern is 4. The present results suggest that by considering the Gleason score and T stage, a larger proportion of patients with prostate cancer than previously thought could avoid a staging bone scan.
根据英国国家临床优化研究所最近的指南指出，对于前列腺特异性抗原（PSA）水平＜10 ng/mL且Gleason评分＜8的患者，无需进行常规的前列腺癌分期骨扫描。本研究旨在确定，如果更多地考虑T分期和Gleason评分，是否有可能在更大比例的患者中排除分期骨扫描。
我们确定了一组1995年1月1日至2000年12月31日期间连续接受未治疗前列腺癌的患者队列，这些患者未接受激素治疗，在扫描后30天内进行了PSA检测，并且在皇家马斯登医院经活检组织学确诊为前列腺癌。根据Gleason评分、主要Gleason分级、临床T分期和PSA水平对数据进行分析。
总共确定了420名符合纳入标准的患者；67次扫描（16%，95%置信区间，CI，13 - 20%）为阳性。在PSA水平≤20 ng/mL、分期＜T4且Gleason评分＜8（主要Gleason分级＜4）的患者中进行的187次扫描中，有2次（1%，0.3 - 4%）报告为阳性，对于这些避免分期骨扫描的标准，阴性预测值为99%（95% CI 98.5 - 99.5%）。在116名Gleason评分为7的患者中（28%），其中28名（24%）扫描为阳性，与主要Gleason模式为3相比，扫描阳性与主要Gleason模式为4之间存在统计学显著关联。
如果PSA水平≤20 ng/mL、分期＜T4且Gleason评分＜8，同位素骨扫描是前列腺癌分期中不必要的部分，除非主要Gleason模式为4，否则应省略。目前的结果表明，通过考虑Gleason评分和T分期，比以前认为的更大比例的前列腺癌患者可以避免进行分期骨扫描。
