Department of Urology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California 90024, USA.
Urology. 2011 Jun;77(6):1330-6. doi: 10.1016/j.urology.2010.12.083. Epub 2011 Apr 13.
To determine the use and subsequent yield of bone scan imaging in a contemporary Veterans Affairs (VA) cohort of men with prostate cancer. With contemporary widespread prostate-specific antigen (PSA) screening, more patients are being diagnosed with low- and intermediate-risk prostate cancer, reducing the need and yield of bone scan imaging.
We retrospectively reviewed the charts of 1598 men diagnosed with prostate cancer from 1998 to 2004 at the Greater Los Angeles and Long Beach VA Medical Centers. We used univariate and multivariate analyses to measure the association between patient (age, race, and comorbidities) and tumor (PSA, clinical stage, Gleason grade) characteristics with bone scan use and subsequent positivity. We conducted the analysis for scans for the entire cohort and those with low and high risk of metastatic disease.
Of 519 men with low-risk disease, 132 (25%) underwent bone scan imaging, none with positive findings. On multivariate analysis for the entire cohort, younger age, Long Beach VA site, increasing PSA level (≥10 ng/mL), clinical stage (cT2 or greater), and Gleason score (≥7) were all positively associated with bone scan use; however, only PSA level ≥20 ng/mL, clinical stage cT3 or greater, and Gleason score ≥4 + 3 corresponded with positivity. A bone scan positivity rate of ≥10% was limited to men with clinical stage cT3 or greater, Gleason score of ≥8, or PSA level of ≥20 ng/mL.
Although decreasing in incidence with time, our results demonstrate extensive overuse of bone scan imaging among VA patients with low-risk prostate cancer. These patterns of overuse for men with low-risk cancer, yielding no positive findings, result in unnecessary patient anxiety and significant economic waste for the VA Healthcare System.
在当代退伍军人事务部（VA）前列腺癌男性队列中，确定骨扫描成像的使用情况及其后续结果。随着当代广泛应用前列腺特异性抗原（PSA）筛查，越来越多的患者被诊断为低危和中危前列腺癌，从而减少了骨扫描成像的需求和收益。
我们回顾性地分析了 1998 年至 2004 年在洛杉矶大地区和长滩 VA 医疗中心诊断为前列腺癌的 1598 名男性的病历。我们使用单变量和多变量分析来衡量患者（年龄、种族和合并症）和肿瘤（PSA、临床分期、Gleason 分级）特征与骨扫描使用及其后续阳性结果之间的关联。我们对整个队列以及低危和高危转移性疾病的患者进行了分析。
在 519 名低危疾病患者中，有 132 名（25%）进行了骨扫描成像，均无阳性发现。在整个队列的多变量分析中，年龄较小、长滩 VA 站点、PSA 水平升高（≥10ng/ml）、临床分期（cT2 或更高）和 Gleason 评分（≥7）均与骨扫描使用呈正相关；然而，只有 PSA 水平≥20ng/ml、临床分期 cT3 或更高、Gleason 评分≥4+3 与阳性结果相对应。骨扫描阳性率≥10%仅限于临床分期 cT3 或更高、Gleason 评分≥8 或 PSA 水平≥20ng/ml 的患者。
尽管随着时间的推移发病率有所下降，但我们的结果表明，VA 低危前列腺癌患者的骨扫描成像过度使用仍很普遍。这些低危癌症患者过度使用骨扫描成像且无阳性发现的模式，导致患者不必要的焦虑和 VA 医疗系统的巨大经济浪费。
