Department of Urology, Yonsei University Health System, Gangnam Severance Hospital, Yongdong, P.O. Box 1217, Seoul, Korea.
World J Urol. 2012 Apr;30(2):265-9. doi: 10.1007/s00345-011-0728-6. Epub 2011 Jul 16.
We evaluated the relationship between bone metastasis (BM) and clinical or pathological variables, including the serum prostate-specific antigen (PSA) concentration.
This retrospective study included 579 consecutive patients with newly diagnosed prostate cancer (Pca) who underwent a bone scan study at our institution between 2002 and 2010. We used receiver operating characteristics curves to evaluate accuracy of bone metastasis between serum PSA 10 and 20 ng/mL.
A positive bone scan result was found in 83 men (14.3%) with PCa. However, 27 men (4.6%) with serum PSA between 10 and 20 ng/mL, 29/579 men (5.0%) with GS ≤ 7, and 21/83 (25.3%) with serum PSA ≤ 20 ng/mL and Gleason score (GS) ≤ 7 had positive bone scans. In the logistic regression analyses, clinical T stage (odds ratio [OR] = 3.26; 95% CI, 2.29-4.33; P = 0.021), GS (OR = 3.41; 95% CI, 2.91-4.63; P = 0.019), and serum PSA (OR = 8.37; 95% CI, 3.91-19.21; P < 0.001) were predictive factors of detecting the BM. When the serum PSA concentration ≤20 ng/mL and GS ≤ 7, AUC value of bone scans for the detection of BM was 0.640 (P = 0.020; 95% CI, 0.563-0.717). With serum PSA at 10 ng/mL and GS ≤ 7, the AUC values of bone scans were 0.828 (P < 0.001; 95% CI, 0.773-0.883).
Bone scans might be necessary in men with serum PSA between 10 and 20 ng/mL. New guidelines for eliminating bone scans in patients with newly diagnosed Pca are needed, especially in Asians.
我们评估了骨转移（BM）与临床或病理变量之间的关系，包括血清前列腺特异性抗原（PSA）浓度。
本回顾性研究纳入了 2002 年至 2010 年间在我院行骨扫描检查的 579 例初诊前列腺癌（Pca）患者。我们使用受试者工作特征曲线评估了血清 PSA 在 10-20ng/mL 之间的骨转移准确性。
在 579 例 Pca 患者中，有 83 例（14.3%）骨扫描阳性。然而，27 例（4.6%）血清 PSA 在 10-20ng/mL 之间、29 例（5.0%）GS≤7、21 例（25.3%）血清 PSA≤20ng/mL 和 Gleason 评分（GS）≤7 的患者骨扫描阳性。在逻辑回归分析中，临床 T 分期（比值比[OR] = 3.26；95%置信区间[CI]：2.29-4.33；P = 0.021）、GS（OR = 3.41；95%CI：2.91-4.63；P = 0.019）和血清 PSA（OR = 8.37；95%CI：3.91-19.21；P < 0.001）是检测 BM 的预测因素。当血清 PSA 浓度≤20ng/mL 和 GS≤7 时，骨扫描检测 BM 的 AUC 值为 0.640（P = 0.020；95%CI：0.563-0.717）。当血清 PSA 为 10ng/mL 且 GS≤7 时，骨扫描的 AUC 值为 0.828（P < 0.001；95%CI：0.773-0.883）。
对于血清 PSA 在 10-20ng/mL 之间的男性，可能需要进行骨扫描。需要制定新的指南来消除新诊断的 Pca 患者的骨扫描，尤其是在亚洲人群中。
