This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dotan, Z. A Articles by Kattan, M. W. Search for Related Content PubMed PubMed Citation Articles by Dotan, Z. A Articles by Kattan, M. W.

Pattern of Prostate-Specific Antigen (PSA) Failure Dictates the Probability of a Positive Bone Scan in Patients With an Increasing PSA After Radical Prostatectomy

From the Departments of Urology, Epidemiology and Biostatistics, Medicine and Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY

Address reprint requests to Michael W. Kattan, PhD, Department of Quantitative Health Sciences, The Cleveland Clinic Foundation, 9500 Euclid Avenue/Wb-4, Cleveland, OH 44195; e-mail: kattanm{at}ccf.org

PURPOSE: Physicians often order periodic bone scans (BS) to check for metastases in patients with an increasing prostate-specific antigen (PSA; biochemical recurrence [BCR]) after radical prostatectomy (RP), but most scans are negative. We studied patient characteristics to build a predictive model for a positive scan.

PATIENTS AND METHODS: From our prostate cancer database we identified all patients with detectable PSA after RP. We analyzed the following features at the time of each bone scan for association with a positive BS: preoperative PSA, time to BCR, pathologic findings of the RP, PSA before the BS (trigger PSA), PSA kinetics (PSA doubling time, PSA slope, and PSA velocity), and time from BCR to BS. The results were incorporated into a predictive model.

RESULTS: There were 414 BS performed in 239 patients with BCR and no history of androgen deprivation therapy. Only 60 (14.5%) were positive for metastases. In univariate analysis, preoperative PSA (P = .04), seminal vesicle invasion (P = .02), PSA velocity (P < .001), and trigger PSA (P < .001) predicted a positive BS. In multivariate analysis, only PSA slope (odds ratio [OR], 2.71; P = .03), PSA velocity (OR, 0.93; P = .003), and trigger PSA (OR, 1.022; P < .001) predicted a positive BS. A nomogram for predicting the bone scan result was constructed with an overfit-corrected concordance index of 0.93.

CONCLUSION: Trigger PSA, PSA velocity, and slope were associated with a positive BS. A highly discriminating nomogram can be used to select patients according to their risk for a positive scan. Omitting scans in low-risk patients could reduce substantially the number of scans ordered.

Supported by the grant SPORE P50-CA58204 from the National Cancer Institute, by funds from The David H. Koch Foundation, and by the National Institutes of Health grant IRGICA76423-0IRI.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

This article has been cited by other articles:

				A. A. Mroczenski, S. M. Berent, A. A. Hall, J. C. Hung, T. J. Herold, and B. P. Mullan Trends of Radiopharmaceutical Use at Mayo Clinic Rochester J. Nucl. Med. Technol., September 1, 2007; 35(3): 154 - 158. [Abstract] [Full Text] [PDF]

				F. E. Lecouvet, D. Geukens, A. Stainier, F. Jamar, J. Jamart, B. J. d'Othee, P. Therasse, B. V. Berg, and B. Tombal Magnetic Resonance Imaging of the Axial Skeleton for Detecting Bone Metastases in Patients With High-Risk Prostate Cancer: Diagnostic and Cost-Effectiveness and Comparison With Current Detection Strategies J. Clin. Oncol., August 1, 2007; 25(22): 3281 - 3287. [Abstract] [Full Text] [PDF]

				H. Hricak, P. L. Choyke, S. C. Eberhardt, S. A. Leibel, and P. T. Scardino Imaging Prostate Cancer: A Multidisciplinary Perspective Radiology, April 1, 2007; 243(1): 28 - 53. [Abstract] [Full Text] [PDF]