Ayyathurai R, Mahapatra R, Rajasundaram R, Srinivasan V, Archard N P, Toussi H
Department of Urology, Glan Clwyd Hospital, Conwy and Denbighshire NHS Trust, Rhyl, Denbigshire, UK.
Urol Int. 2006;76(3):209-12. doi: 10.1159/000091620.
This study aimed to evaluate the role of bone scan as a staging investigation in newly diagnosed untreated prostate cancers.
Bone scan results in patients with newly diagnosed prostate cancer were reviewed and correlated with clinical stage, prostate-specific antigen (PSA) and Gleason scores from the biopsy specimen.
In all, 124 patients fulfilled inclusion criteria with an age range of 51-94 (mean 72.3) years. Pre-biopsy PSA ranged from 2.2 to 5,864 with a median of 21.1 ng/ml. Clinical stage was T0-T1c 14.5%, T2a 41.9%, T2b 17.7%, T3 16.9%, and T4 9%. A Gleason score of 7 was found in 31%. Four patients' samples were not suitable for Gleason scoring. Twenty patients (16.1%) had a positive bone scan with a mean age of 79.4 years (median 83). Two patients with PSA<20 ng/ml were positive. Of the 44 scans performed in the patients with PSA<or=20 ng/ml, clinical stage<T4 and Gleason sum<or=7 (with the major Gleason<4), none was positive. The above criteria give a 100% negative predictive value for avoiding bone scans as a staging investigation.
Staging bone scan can be safely omitted in patients with a clinical stage of <T4, PSA level of <or=20 ng/ml and a Gleason score of <or=7 (with major Gleason pattern<4) unless the symptoms are suggestive of metastasis.
本研究旨在评估骨扫描在新诊断未经治疗的前列腺癌分期检查中的作用。
回顾新诊断前列腺癌患者的骨扫描结果，并将其与临床分期、活检标本的前列腺特异性抗原（PSA）和 Gleason 评分进行关联分析。
共有 124 例患者符合纳入标准，年龄范围为 51 - 94 岁（平均 72.3 岁）。活检前 PSA 范围为 2.2 至 5864，中位数为 21.1 ng/ml。临床分期为 T0 - T1c 占 14.5%，T2a 占 41.9%，T2b 占 17.7%，T3 占 16.9%，T4 占 9%。Gleason 评分为 7 的占 31%。4 例患者的样本不适合进行 Gleason 评分。20 例患者（16.1%）骨扫描呈阳性，平均年龄为 79.4 岁（中位数 83 岁）。2 例 PSA<20 ng/ml 的患者骨扫描呈阳性。在 PSA≤20 ng/ml、临床分期<T4 且 Gleason 总分≤7（主要 Gleason<4）的患者中进行的 44 次扫描，无一例呈阳性。上述标准对于避免将骨扫描作为分期检查具有 100%的阴性预测价值。
对于临床分期<T4、PSA 水平≤20 ng/ml 且 Gleason 评分≤7（主要 Gleason 模式<4）的患者，可以安全地省略分期骨扫描，除非有症状提示转移。
