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Are serial bone scans useful for the follow‐up of clinically localized, low to intermediate grade prostate cancer managed with watchful observation alone?
Author(s) -
Yap B.K.,
Choo R.,
Deboer G.,
Klotz L.,
Danjoux C.,
Morton G.
Publication year - 2003
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.2003.04169.x
Subject(s) - medicine , watchful waiting , prostate cancer , bone scintigraphy , bone metastasis , prostate specific antigen , prostate , radiology , prospective cohort study , metastasis , surgery , cancer , nuclear medicine
OBJECTIVE To assess the predictive value of serial bone scans as a surveillance tool for bone metastasis in men with clinically localized prostate cancer and managed with watchful observation. PATIENTS AND METHODS A prospective single‐arm study was conducted to assess the feasibility of a watchful observation protocol with selective delayed intervention for patients with clinically localized prostate cancer, i.e. T1b‐T2bN0M0, a Gleason score of ≤ 7 and a prostate‐specific antigen (PSA) level of ≤ 15 ng/mL. Patients were managed expectantly as long as they did not meet the empirically predefined criteria of clinical, histological or PSA progression. Bone scintigraphy was repeated every year for the first 2 years, then every 2 years thereafter if the patient remained on watchful observation. When the follow‐up PSA level was> 15 ng/mL the patient underwent bone scintigraphy every year. RESULTS In all, 244 eligible patients were enrolled into the study. With a median follow‐up of 30 months, 449 bone scans were taken (150 at baseline and 299 in follow‐up evaluations); all 299 follow‐up scans were negative for bone metastasis. Hence, the true rate of positive follow‐up bone scans was estimated to be 0–1.0% (95% confidence). In all, 171 patients had at least one follow‐up bone scan; of these, the number (%) of patients who had 1, 2, 3, 4 and ≥ 5 follow‐up scans was 89 (52), 53 (31), 17 (10), eight (4.7) and four (2.3), respectively. The PSA levels (ng/mL) corresponding to all follow‐up bone scans were: 214 scans at PSA < 10, 61 at 10–14.9, 18 at 15–19.9 and six at ≥ 20 (range 20.2–24.9). The probability of a negative bone scan was estimated to be 88–100% (95% confidence interval) when a PSA threshold of 15 ng/mL was used. CONCLUSION The probability of positive findings in serial bone scans in untreated, localized, low to intermediate grade prostate cancer was low when the follow‐up PSA level remained < 15 ng/mL. Avoiding bone scans in this group of patients would translate into a significant cost saving and reduction in their psychological and physical burden. As for those with a follow‐up PSA of> 15 ng/mL, the role of serial bone scintigraphy remains undefined, as a longer follow‐up and a larger sample are needed.