Poenateetai Chanikarn, Teyateeti Achiraya, Pusuwan Pawana, Teyateeti Ajalaya
Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Asia Ocean J Nucl Med Biol. 2025;13(2):146-155. doi: 10.22038/aojnmb.2025.82544.1582.
To determine the detection rate of bone metastasis on bone scan of prostate cancer patients with rising serum prostate-specific antigen (PSA) following radical prostatectomy (RP) and to identify the predictive factors associated with bone metastasis.
A study was conducted in 120 patients with rising serum PSA after RP. The data collected were pre and post-RP clinical parameters, including a trigger PSA (tPSA) level that prompted the treating physician to request a bone scan and PSA doubling time (PSADT). Bone scans were classified as positive or negative in conjunction with follow-up imaging and clinical information.
Of 120 bone scans, 6 (5%) were positive and 114 (95%) were negative for bone metastasis. In the median tPSA ranges of <0.5, 0.5-1.0, and >1.0 ng/mL, scan positivity was 2.1%, 6.3%, and 30%, respectively. Patients with positive scans showed higher tPSA (1.228 vs 0.256 ng/mL; p=0.003) and shorter PSADT (3.5 vs 12.2 months; p=0.005) than those with negative scans. The most significant predictors of a positive bone scan were tPSA (>1 vs ≤1 ng/mL; OR 15.286, 95% CI 2.594-90.064, p=0.003) and PSADT (<6 vs ≥6 months; OR 17.333, 95% CI 1.618-185.646, p=0.018).
The detection rate of bone metastasis on bone scans in post-RP recurrent prostate cancer patients is only 5%, but the probability is much higher with tPSA >1 ng/mL and PSADT <6 months. Given its wide accessibility in Thailand, a bone scan should remain the preferred screening test for bone metastasis, with expected positive results in patients with high or rapidly rising PSA levels.
确定前列腺癌患者根治性前列腺切除术后血清前列腺特异性抗原（PSA）升高时骨扫描的骨转移检出率，并识别与骨转移相关的预测因素。
对120例根治性前列腺切除术后血清PSA升高的患者进行了一项研究。收集的数据为根治性前列腺切除术前和术后的临床参数，包括促使治疗医生要求进行骨扫描的触发PSA（tPSA）水平和PSA倍增时间（PSADT）。结合后续影像学检查和临床信息，将骨扫描分为阳性或阴性。
120次骨扫描中，6例（5%）骨转移阳性，114例（95%）阴性。在tPSA中位数范围<0.5、0.5 - 1.0和>1.0 ng/mL时，扫描阳性率分别为2.1%、6.3%和30%。扫描阳性的患者比扫描阴性的患者tPSA更高（1.228 vs 0.256 ng/mL；p = 0.003），PSADT更短（3.5 vs 12.2个月；p = 0.005）。骨扫描阳性的最显著预测因素是tPSA（>1 vs ≤1 ng/mL；OR 15.286，95% CI 2.594 - 90.064，p = 0.003）和PSADT（<6 vs ≥6个月；OR 17.333，95% CI 1.618 - 185.646，p = 0.018）。
根治性前列腺切除术后复发性前列腺癌患者骨扫描的骨转移检出率仅为5%，但当tPSA>1 ng/mL且PSADT<6个月时，发生骨转移的可能性要高得多。鉴于骨扫描在泰国易于进行，它应仍然是骨转移的首选筛查检查，预计PSA水平高或快速升高的患者会出现阳性结果。
