Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Eur Radiol. 2022 Dec;32(12):8266-8275. doi: 10.1007/s00330-022-08945-7. Epub 2022 Aug 8.
The European Association of Urology (EAU) recommends a bone scan for newly diagnosed unfavorable intermediate- and high-risk prostate cancer. We aimed to validate the screening criteria for bone metastases in patients with treatment-naïve prostate cancer.
This single-center retrospective study included all patients with treatment-naïve unfavorable intermediate- or high-risk prostate cancer. All underwent MRI of the lumbar column (T2Dixon) and pelvis (3DT2w, DWI, and T2 Dixon). The presence and location of lymph node and bone metastases were registered according to risk groups and radiological (rad) T-stage. The risk of lymph node metastases was assessed by odds ratio (OR).
We included 390 patients, of which 68% were high-risk and 32% were unfavorable intermediate-risk. In the high-risk group, the rate of regional- and non-regional lymph node metastases was 11% and 6%, respectively, and the rate of bone metastases was 10%. In the unfavorable intermediate-risk group, the rate of regional- and non-regional lymph node metastases was 4% and 0.8%, respectively, and the rate of bone metastases was 0.8%. Metastases occurred exclusively in the lumbar column in 0.5% of all patients, in the pelvis in 4%, and the pelvis and lumbar column in 3%. All patients with bone metastases had radT3-4, and patients with radT3-4 showed a four-fold increased risk of lymph node metastases (OR 4.48, 95% CI: 2.1-9.5).
Bone metastases were found in 10% with high-risk prostate cancer and 0.8% with unfavorable intermediate-risk. Therefore, we question the recommendation to screen the unfavorable intermediate-risk group for bone metastases.
• The rate of bone metastases was 10% in high-risk patients and 0.8% in the unfavorable intermediate-risk group. • The rate of lymph-node metastases was 17% in high-risk patients and 5% in the unfavorable intermediate-risk group. • No bone metastases were seen in radiologically localized disease.
欧洲泌尿外科学会（EAU）建议对新诊断的预后不良的中高危前列腺癌进行骨扫描。我们旨在验证初治前列腺癌患者骨转移的筛查标准。
这项单中心回顾性研究纳入了所有初治中高危前列腺癌患者。所有患者均接受腰椎（T2 Dixon）和骨盆（3DT2w、DWI 和 T2 Dixon）磁共振成像检查。根据风险组和影像学（rad）T 分期，记录淋巴结和骨转移的存在和位置。采用比值比（OR）评估淋巴结转移的风险。
我们纳入了 390 例患者，其中 68%为高危，32%为预后不良的中危。在高危组中，区域和非区域淋巴结转移的发生率分别为 11%和 6%，骨转移的发生率为 10%。在预后不良的中危组中，区域和非区域淋巴结转移的发生率分别为 4%和 0.8%，骨转移的发生率为 0.8%。所有骨转移患者的 radT3-4，且 radT3-4 患者的淋巴结转移风险增加 4 倍（OR 4.48，95%CI：2.1-9.5）。
高危前列腺癌患者中 10%和预后不良的中危患者中 0.8%出现骨转移。因此，我们对筛查预后不良的中危组骨转移的建议提出质疑。
高危患者骨转移率为 10%，预后不良的中危组为 0.8%。
高危患者淋巴结转移率为 17%，预后不良的中危组为 5%。
影像学局限性疾病未见骨转移。
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