Are Bone Scans Necessary In Men With Low Prostate Specific Antigen Levels Following Localized Therapy?

UroToday.com - The diagnosis of bony metastasis secondary to prostate cancer significantly alters patient treatment. Currently radionuclide bone scans are the gold standard for detecting osseous metastasis. A correlation between the presence of bony metastases and serum PSA has been observed. An ongoing debate surrounds the optimal PSA for recommending a bone scan for nonmetastatic prostate cancer.

In a recent study reported by K. S. Warren and colleagues from the Midwest Urology Research Foundation, data obtained from the Early Prostate Cancer Trial comparing placebo with bicalutamide in addition to standard care for localized prostate was analyzed. As part of the trial, patients were required to have routine bone scans regardless of PSA levels. The PSA levels were divided into subgroups and the incidence of positive bone scans was calculated for each group. The study is published in the July 2006 issue of the Journal of Urology.

Analysis of results showed that the incidence of positive bone scans in patients treated with watchful waiting and given bicalutamide or placebo was low (0.7% to 3.2%) at PSA levels less than 20 ng/ml. In the groups treated with radical prostatectomy or radiotherapy, regardless of the addition of bicalutamide, the incidence of positive bone scans was low (0.2% to 1.4%) at PSA levels less than 5 ng/ml.

As a result of this analysis, the authors suggest that bone scans can be confidently eliminated in the follow-up of patients with early prostate cancer after standard care when the PA levels remain lower than 5 ng/ml. This level can be increased to 20 ng/ml with caution in those patients treated with watchful waiting.

By Michael J. Metro, MD

J Urol. Volume 176, Issue 1, Pages 70-74 (July 2006)
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