Bone metastasis is a common feature of advanced prostate disease. The radionuclide bone scan is an excellent method for assessing skeletal spread of the disease.This study sets out to determine whether there is a critical level of serum prostate serum antigen (PSA) and Gleason score below which routine bone scans may prove to be of minimal value in the diagnosis of skeletal metastases. This study compares the serum PSA levels and Gleason score of prostate cancer patients with findings on radionuclide bone scans.

268 patients with histologically proven prostate cancer underwent radionuclide bone scans over a 19 month period. A retrospective review of the case-notes and bone scans was performed on this cohort with data compiled on :-individual serum PSA levels Gleason score TNM classification histology report bone scan result Exclusion criteria was patients who had received any form of prostate cancer treatment prior to the evaluation of their serum PSA, including radical prostatectomy, radiation therapy or hormone treatment. This is because studies have shown that the expression...

Serum PSA and radionuclide bone scan findings A total of 167 men were included in the final population for analysis. The age range for the patient population was 35 - 93 years. Table 1: Descriptive statistics for serum PSA values.Bone Scan ResultMean Serum PSA level (ng/ml)Serum PSA level range (ng/ml)Standard Deviation (ng/ml)+ve for skeletal metastases499.29.1 - 2747751.77-ve for skeletal metastases45.90.1 - 2000176.90Inconclusive for skeletal metastases63.84.3 - 184.663.96Table 2: Descriptive statistics for serum PSA values and bone scan findings.Serum PSA level (ng/ml)No of patients bone scan...

In summary, this study shows that :-There is a significant difference in serum PSA values between patients found to be bone scan negative for skeletal metastases and those found to be bone scan positive for skeletal metastases The negative predictive value of serum PSA at a cut-off point of 20ng/ml is 98.9% There is a significant difference in Gleason score between patients found to be bone scan negative for skeletal metastases and those found to be bone scan positive for skeletal metastases. The relationship between...

1. Leo ME, Bilhartz DL, Bergstralh EJ & Oesterling JE. Prostate Specific Antigen in Hormonally Treated Stage D2 Prostate Cancer: Is it always an accurate indicator of disease status? Journal of Urology 1991;145:802-62. Rifkin MD, Kurtz AB, Choi HY & Goldberg BB. Endoscopic ultrasonic evaluation of the prostate using a transrectal probe : Prospective evaluation and acoustic characterization. Radiology 1983;149:265-2713. Lee N, Fawaaz R, Olsson CA, Benson MC, Petrylak CP, Schiff PB, Bagiella E, Singh A & Ennis RD. Which patients with newly diagnosed prostate...

This study was conducted at the Department of Nuclear Medicine, Royal Liverpool Hospital, Liverpool, United Kingdom.