Pattern of prostate-specific antigen (PSA) failure dictates the probability of a positive bone scan in patients with an increasing PSA after radical prostatectomy.

Authors

• Zohar A Dotan
• Fernando J Bianco
• Farhang Rabbani
• James A Eastham
• Paul Fearn
• Howard I Scher
• Kevin W Kelly
• Hui-Ni Chen
• Heiko Schöder
• Hedvig Hricak
• Peter T Scardino
• Michael W Kattan

Publication/Presentation Date

3-20-2005

Abstract

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.

Volume

23

Issue

9

First Page

1962

Last Page

1968

ISSN

0732-183X

Published In/Presented At

Dotan, Z. A., Bianco, F. J., Jr, Rabbani, F., Eastham, J. A., Fearn, P., Scher, H. I., Kelly, K. W., Chen, H. N., Schöder, H., Hricak, H., Scardino, P. T., & Kattan, M. W. (2005). Pattern of prostate-specific antigen (PSA) failure dictates the probability of a positive bone scan in patients with an increasing PSA after radical prostatectomy. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 23(9), 1962–1968. https://doi.org/10.1200/JCO.2005.06.058

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

15774789

Department(s)

Administration and Leadership

Document Type

Article