Gleave M E, Coupland D, Drachenberg D, Cohen L, Kwong S, Goldenberg S L, Sullivan L D
Department of Surgery and Radiology, University of British Columbia, Vancouver Hospital and Health Sciences Centre, Canada.
Urology. 1996 May;47(5):708-12. doi: 10.1016/s0090-4295(96)80016-1.
To determine whether pretreatment serum prostate-specific antigen (PSA) levels in newly diagnosed prostate cancer patients can identify a group with a low probability of osseous metastasis and safely eliminate the need for a bone scan as a routine part of the staging evaluation.
We retrospectively reviewed 683 patients with prostate cancer between 1990 and 1993. Patients with prior therapy or serum PSA levels obtained longer than 3 months prior to bone scan were excluded. Bone scans were reviewed by two nuclear medicine physicians with a third deciding equivocal cases.
Only 6% of 490 evaluable patients had a positive bone scan on initial evaluation. Scans were positive in 0 of 290 (0%) with PSA levels below 10 micrograms/L, 4 of 88 (4.5%) with PSA levels between 10 and 20 micrograms/L, and 24 of 112 (21%) with PSA levels above 20 micrograms/L. Although the risk of a positive bone scan increased with increasing PSA levels, PSA is a poor positive predictor of positive bone scans. The risk of a positive bone scan was 8% (5 of 64 patients) when PSA was between 20 and 50 micrograms/L, and increased to 40% (19 of 48 patients) for PSA levels greater than 50 micrograms/L. In contrast, serum PSA levels below 10 micrograms/L are strong negative predictors of positive bone scans, with no positive scans in 290 patients with PSA levels below 10 micrograms/L. Although the risk of a positive bone scan increased with increasing stage and grade, tumor stage and grade were poor negative predictors of positive bone scans. Up to 4% of patients with clinically confined or well-differentiated to moderately differentiated tumors had positive scans. Scans were positive in 12% of poorly differentiated tumors, but all these patients had PSA levels above 10 micrograms/L.
Our data support the elimination of routine bone scintigraphy in patients with newly diagnosed prostate cancer and PSA levels below 10 micrograms/L. Bone scans are indicated when PSA levels are above 10 micrograms/L, or with T3 or poorly differentiated disease.
确定新诊断的前列腺癌患者治疗前血清前列腺特异性抗原（PSA）水平是否能识别出骨转移可能性低的患者群体，并安全地消除将骨扫描作为分期评估常规部分的必要性。
我们回顾性分析了1990年至1993年间的683例前列腺癌患者。排除先前接受过治疗或在骨扫描前3个月以上测得血清PSA水平的患者。两名核医学医师对骨扫描结果进行评估，如有疑难病例则由第三名医师裁决。
在490例可评估患者中，初始评估时仅6%的患者骨扫描呈阳性。PSA水平低于10微克/升的290例患者中，骨扫描阳性者为0例（0%）；PSA水平在10至20微克/升之间的88例患者中，有4例（4.5%）阳性；PSA水平高于20微克/升的112例患者中，有24例（21%）阳性。尽管骨扫描阳性风险随PSA水平升高而增加，但PSA对骨扫描阳性的预测能力较差。PSA在20至50微克/升之间时，骨扫描阳性风险为8%（64例患者中有5例）；PSA水平大于50微克/升时，阳性风险增至40%（48例患者中有19例）。相比之下，PSA水平低于10微克/升是骨扫描阳性的强有力阴性预测指标，290例PSA水平低于10微克/升的患者中无骨扫描阳性者。尽管骨扫描阳性风险随分期和分级增加而增加，但肿瘤分期和分级对骨扫描阳性的阴性预测能力较差。高达4%的临床局限性或高分化至中分化肿瘤患者骨扫描呈阳性。低分化肿瘤患者中12%骨扫描阳性，但所有这些患者PSA水平均高于10微克/升。
我们的数据支持对新诊断的PSA水平低于10微克/升的前列腺癌患者无需进行常规骨闪烁扫描。当PSA水平高于10微克/升，或存在T3期或低分化疾病时，需进行骨扫描。
