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Panunzio A, Sorce G, Hoeh B, Hohenhorst L, Tappero S, Nimer N, Rajwa P, Tian Z, Terrone C, Chun FKH, Briganti A, Saad F, Shariat SF, Cerruto MA, Antonelli A, Karakiewicz PI. Effect of positive surgical margins at radical prostatectomy on cancer-specific mortality in high/very high-risk prostate cancer patients with Gleason Grade Group 4-5. Prostate 2023; 83:268-276. [PMID: 36336728 DOI: 10.1002/pros.24458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/18/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of positive surgical margins (PSM) on cancer specific mortality (CSM) in high/very high-risk (HR/VHR) prostate cancer (PCa) with aggressive Gleason Grade Group (GGG) is unknown. We tested PSM effect on CSM in this setting, in addition to testing of radiotherapy (RT) benefit in PSM patients. METHODS We relied on Surveillance, Epidemiology, and End Results database (2010-2015), focusing on HR/VHR patients with exclusive GGG 4-5 at radical prostatectomy (RP). Kaplan-Meier plots and multivariable Cox regression models tested the relationship between PSM and CSM. Moreover, the effect of RT on CSM was explored in PSM patients. RESULTS Of 3383 HR/VHR patients, 15.1% (n = 511) exhibited PSM. Patients with PSM harbored higher rates of GGG 5 (60.1% vs. 50.9%, p < 0.001), pathologic tumor stage T3a (69.1% vs. 45.2%, p < 0.001) and lymph node involvement (14.1% vs. 9.4%, p < 0.001), relative to patients without PSM. PSM rates decreased over time (2010-2015) from 16.0% to 13.6%. Seven-year CSM-free survival rates were 91.6% versus 95.7% in patients with and without PSM, respectively. In multivariable Cox regression models, PSM was an independent predictor of CSM (hazard ratio = 1.6, p = 0.040) even after adjustment for age, prostate specific antigen, pathologic tumor stage and lymph node status. Finally, in PSM patients, RT delivery did not reduce CSM in either univariable or multivariable Cox regression models. CONCLUSIONS In HR/VHR PCa patients with exclusive GGG 4-5, PSM at RP adversely affect survival. Moreover, RT has no protective effect on CSM. In consequence, lowest possible PSM rates are crucial in such patients.
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Affiliation(s)
- Andrea Panunzio
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Gabriele Sorce
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Benedikt Hoeh
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lukas Hohenhorst
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stefano Tappero
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
| | - Nancy Nimer
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Carlo Terrone
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alberto Briganti
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Departments of Urology, Weill Cornell Medical College, New York City, New York, USA
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
- Division of Urology, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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Inconclusive Bone Scan in Men with Intermediate and High-risk Prostate Cancer: What next? Semin Oncol Nurs 2020; 36:151046. [PMID: 32693961 DOI: 10.1016/j.soncn.2020.151046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the incidence of inconclusive bone scans and down-stream imaging and clinical follow-up generated, including subsequent treatment outcomes in men affected by inconclusive bone scans with intermediate- and high-risk prostate cancer. DATA SOURCES Retrospective study of clinical data for a Scottish population of men diagnosed with prostate cancer in the intermediate and high-risk groups. CONCLUSION Of the 1,246 patients included, initially 81 men were identified as having an inconclusive bone scan result following multidisciplinary team discussion. After further imaging, 24 patients remained inconclusive for metastasis. Of these, two patients received no treatment; one because of a watchful waiting decision, and one because of death. Of the 13 patients receiving radical treatment (laparoscopic radical prostatectomy or radiotherapy), three patients showed relapse (23%) indicating presence of microscopic disease and failure of radical treatment alone for these patients. IMPLICATIONS FOR NURSING PRACTICE This paper will assist nurses and multidisciplinary team members in understanding how patients diagnosed with intermediate- and high-risk prostate cancer with inconclusive bone scan results are subsequently imaged and managed in the current health care system. This raises awareness amongst nursing staff of disease recurrence and the possibility of downstream multimodality treatment for these men with inconclusive bone scans.
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Ma MW, Gao XS, Lyu F, Gu XB, Yin H, Li HZ, Li XY, Qi X, Bai Y, Chen JY. Development of a nomogram predicting metastatic disease and the assessment of NCCN, AUA and EAU guideline recommendations for bone imaging in prostate cancer patients. World J Urol 2020; 39:1815-1823. [PMID: 32691147 PMCID: PMC8217023 DOI: 10.1007/s00345-020-03363-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/11/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose We identified the risk predictors related to prostate cancer (PCa) metastasis using contemporary data in a community setting. Then, we assessed the performance of indications for bone imaging recommended from the NCCN, AUA and EAU guidelines. Methods Using the Surveillance, Epidemiology, and End Results database (2010–2015), we collected clinicopathological information from PCa patients. The associated risk factors found by multivariate analyses were used to establish forest plots and nomograms for distant metastasis (DM) and bone(s)-only metastasis (BM). We next evaluated the NCCN, AUA and EAU guidelines indications for the discovery of certain subgroups of patients who should receive bone imaging. Results A total of 120,136 patients were eligible for analysis, of which 96.7% had no metastasis. The odds ratios of positive DM and BM results were 13.90 times and 15.87 times higher in patients with a histologic grade group (GG) 5 than in the reference group. The concordance index of the nomograms based on race, age, T/N stage, PSA, GG, percentage of positive scores for predicting DM and BM was 0.942 and 0.928, respectively. Performance of the NCCN, AUA and EAU guidelines was high and relatively similar in terms of sensitivity (93.2–96.9%) and negative predictive value (99.8–99.9%). NCCN guidelines had the highest accuracy, specificity and positive likelihood ratio, while negative likelihood ratio was lowest in AUA guideline. Conclusion Histologic GG 5 was the foremost factor for DM and BM. NCCN-based recommendations may be more rational in clinical practice. Nomograms predicting metastasis demonstrate high accuracy. Electronic supplementary material The online version of this article (10.1007/s00345-020-03363-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming-Wei Ma
- Department of Radiation Oncology, Peking University First Hospital, No. 7 Xishiku Street, Beijing, 100034, People's Republic of China
| | - Xian-Shu Gao
- Department of Radiation Oncology, Peking University First Hospital, No. 7 Xishiku Street, Beijing, 100034, People's Republic of China.
| | - Feng Lyu
- Department of Radiation Oncology, Peking University First Hospital, No. 7 Xishiku Street, Beijing, 100034, People's Republic of China
| | - Xiao-Bin Gu
- Department of Radiation Oncology, Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Huan Yin
- Department of Health Science & Technology Strategy Information, Chinese Academy of Medical Sciences & Peking Union Medical College Institute of Medical Information, Beijing, China
| | - Hong-Zhen Li
- Department of Radiation Oncology, Peking University First Hospital, No. 7 Xishiku Street, Beijing, 100034, People's Republic of China
| | - Xiao-Ying Li
- Department of Radiation Oncology, Peking University First Hospital, No. 7 Xishiku Street, Beijing, 100034, People's Republic of China
| | - Xin Qi
- Department of Radiation Oncology, Peking University First Hospital, No. 7 Xishiku Street, Beijing, 100034, People's Republic of China
| | - Yun Bai
- Department of Radiation Oncology, Peking University First Hospital, No. 7 Xishiku Street, Beijing, 100034, People's Republic of China
| | - Jia-Yan Chen
- Department of Radiation Oncology, Peking University First Hospital, No. 7 Xishiku Street, Beijing, 100034, People's Republic of China
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Soydal C, Nak D, Araz M, Akkus P, Urun Y, Ozkan E, Kucuk NO, Kir MK. Comparison of bone scintigraphy and Ga-68 prostate-specific membrane antigen positron emission tomography/computed tomography in the detection of bone metastases of prostate carcinoma. Nucl Med Commun 2020; 40:1243-1249. [PMID: 31688499 DOI: 10.1097/mnm.0000000000001106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM This study aims to assess the diagnostic performance of Ga-68 prostate-specific membrane antigen PET/computed tomography in the comparison of planar bone scintigraphy in the detection of bone metastases. Another purpose is to define the additional benefit of bone scintigraphy subsequent to prostate-specific membrane antigen PET/computed tomography and the role of prostate-specific membrane antigen PET/computed tomography in the treatment planning. MATERIAL AND METHOD Forty-six patients with a median interval of 19 (range: 3-90) days between prostate-specific membrane antigen PET/computed tomography and bone scintigraphy included in the analysis. Diagnostic performance of both modalities was calculated and compared. RESULTS Prostate-specific membrane antigen PET/computed tomography and bone scintigraphy were performed for initial staging in 25 (54%), for evaluation of biochemical recurrence in 11 (24%) and metastatic castration-resistant prostate carcinoma in 10 (22%) patients. In the patient-based analysis sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for bone scintigraphy for detection of bone metastases were calculated as 50%, 19-29%, 32-39%, 32-39%, and 33-39%, respectively, based on whether equivocal findings were classified as positive or negative. For prostate-specific membrane antigen PET/computed tomography, these values were found significantly higher as 100%, 95-100%, 98-100%, 96-100%, and 100%, respectively. The diagnostic performance of bone scintigraphy and PET/computed tomography in clinical subgroups was analyzed, prostate-specific membrane antigen PET/computed tomography was superior to bone scintigraphy in three groups. CONCLUSION In this retrospective study, prostate-specific membrane antigen PET/computed tomography was found to be superior to planar bone scintigraphy in the detection of bone metastases. Additional bone scintigraphy seems to be unnecessary in patients who underwent prostate-specific membrane antigen PET/computed tomography within three months period without additional treatment.
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Affiliation(s)
| | | | | | | | - Yuksel Urun
- Medical Oncology Departments of Ankara University Medical School, Ankara, Turkey
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Nuclear Medicine Imaging Techniques of the Musculoskeletal System. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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6
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The Impact of Lymph Node Metastases Burden at Radical Prostatectomy. Eur Urol Focus 2019; 5:399-406. [DOI: 10.1016/j.euf.2017.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/08/2017] [Accepted: 12/19/2017] [Indexed: 11/19/2022]
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Haran C, McBean R, Parsons R, Wong D. Five‐year trends of bone scan and prostate‐specific membrane antigen positron emission tomography utilization in prostate cancer: A retrospective review in a private centre. J Med Imaging Radiat Oncol 2019; 63:495-499. [DOI: 10.1111/1754-9485.12885] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/14/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Crishan Haran
- School of Medicine University of Queensland Brisbane Queensland Australia
| | - Rhiannon McBean
- Wesley Medical Imaging The Wesley Hospital Brisbane Queensland Australia
| | - Rex Parsons
- Wesley Medical Imaging The Wesley Hospital Brisbane Queensland Australia
| | - David Wong
- Wesley Medical Imaging The Wesley Hospital Brisbane Queensland Australia
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Amoako YA, Hammond ENB, Assasie-Gyimah A, Laryea DO, Ankrah A, Amoah G. Prostate-specific antigen and risk of bone metastases in west Africans with prostate cancer. World J Nucl Med 2019; 18:143-148. [PMID: 31040745 PMCID: PMC6476246 DOI: 10.4103/wjnm.wjnm_38_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We aimed to assess the relationship between bone scintigraphy findings and prostate-specific antigen (PSA) and Gleason score in a group of treatment naïve West Africans with prostate cancer. The age, PSA, and Gleason scores of 363 patients with prostate cancer were collected. Patients were risk stratified using the D'Amico criteria. Logistic regression was performed to assess the relationship between bone scan results and PSA and Gleason score. Receiver operating characteristics (ROC) analysis was used to determine the diagnostic reliability of the bone scan findings. Ninety of the 96 patients with metastases had high risk, and only 6 had low-to-intermediate risk disease (P = 0.0001). PSA (odds ratio [OR] 2.4 [95% confidence interval [CI] 1.5-3.8], P = 0.001) and GS (OR 2.2 [95% CI 1.5-3.1], P = 0.001) were independently predictive of the presence of metastases. ROC analysis revealed that PSA predicted the presence of metastases with an area under the curve of 0.72, and using a cut-off value of ≥20 predicted metastases with a sensitivity of 86.5% and specificity of 41.2%. A Gleason score of ≥7 had an 89.6% sensitivity and 34.8% specificity for bone metastases. Using a Gleason cutoff of ≥8, the sensitivity and specificity for predicting bone metastases were 54.2% and 71.5%, respectively. The area under the Gleason score ROC curve was 0.68. PSA and Gleason score are independent predictors of the presence of bone metastases in West Africans with prostate cancer.
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Affiliation(s)
- Yaw Ampem Amoako
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana, West Africa
| | - Emmanuel Nii Boye Hammond
- Department of Nuclear Medicine Service, Korle Bu Teaching Hospital, Accra, Ghana, West Africa
- Department of Ghana Atomic Energy Commission, Accra, Ghana, West Africa
| | - Awo Assasie-Gyimah
- Department of Nuclear Medicine Service, Korle Bu Teaching Hospital, Accra, Ghana, West Africa
| | - Dennis Odai Laryea
- Department of Non Communicable Disease Control Programme, Ghana Health Service Headquarters, Accra, Ghana, West Africa
| | - Alfred Ankrah
- Department of Nuclear Medicine Service, Korle Bu Teaching Hospital, Accra, Ghana, West Africa
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Netherland
| | - George Amoah
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana, West Africa
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Rates of Positive Surgical Margins and Their Effect on Cancer-specific Mortality at Radical Prostatectomy for Patients With Clinically Localized Prostate Cancer. Clin Genitourin Cancer 2019; 17:e130-e139. [DOI: 10.1016/j.clgc.2018.09.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/24/2018] [Accepted: 09/27/2018] [Indexed: 12/22/2022]
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11
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Preisser F, Nazzani S, Bandini M, Marchioni M, Tian Z, Saad F, Chun FKH, Shariat SF, Montorsi F, Huland H, Graefen M, Tilki D, Karakiewicz PI. Racial disparities in lymph node dissection at radical prostatectomy: A Surveillance, Epidemiology and End Results database analysis. Int J Urol 2018; 25:929-936. [DOI: 10.1111/iju.13780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/17/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Felix Preisser
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Cancer Prognostics and Health Outcomes Unit; Division of Urology; University of Montreal Health Center; Montreal Quebec Canada
| | - Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit; Division of Urology; University of Montreal Health Center; Montreal Quebec Canada
- Academic Department of Urology; IRCCS Policlinico San Donato; University of Milan; Milan Italy
| | - Marco Bandini
- Cancer Prognostics and Health Outcomes Unit; Division of Urology; University of Montreal Health Center; Montreal Quebec Canada
- Department of Urology and Division of Experimental Oncology; Urological Research Institute; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - Michele Marchioni
- Cancer Prognostics and Health Outcomes Unit; Division of Urology; University of Montreal Health Center; Montreal Quebec Canada
- Department of Urology; SS Annunziata Hospital; “G.D'Annunzio” University of Chieti; Chieti Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit; Division of Urology; University of Montreal Health Center; Montreal Quebec Canada
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit; Division of Urology; University of Montreal Health Center; Montreal Quebec Canada
| | - Felix KH Chun
- Department of Urology; University Hospital Frankfurt am Main; Frankfurt am Main Germany
| | | | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology; Urological Research Institute; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit; Division of Urology; University of Montreal Health Center; Montreal Quebec Canada
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12
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Preisser F, Nazzani S, Bandini M, Marchioni M, Tian Z, Montorsi F, Saad F, Briganti A, Steuber T, Budäus L, Huland H, Graefen M, Tilki D, Karakiewicz PI. Increasing rate of lymph node invasion in patients with prostate cancer treated with radical prostatectomy and lymph node dissection. Urol Oncol 2018; 36:365.e1-365.e7. [DOI: 10.1016/j.urolonc.2018.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/11/2018] [Accepted: 05/15/2018] [Indexed: 10/14/2022]
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13
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Preisser F, Marchioni M, Nazzani S, Bandini M, Tian Z, Saad F, Pompe RS, Briganti A, Budäus L, Montorsi F, Huland H, Graefen M, Tilki D, Karakiewicz PI. Trend of Adverse Stage Migration in Patients Treated with Radical Prostatectomy for Localized Prostate Cancer. Eur Urol Oncol 2018; 1:160-168. [DOI: 10.1016/j.euo.2018.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/02/2018] [Accepted: 03/20/2018] [Indexed: 11/29/2022]
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14
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Preisser F, Bandini M, Marchioni M, Nazzani S, Tian Z, Pompe RS, Fossati N, Briganti A, Saad F, Shariat SF, Heinzer H, Huland H, Graefen M, Tilki D, Karakiewicz PI. Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion. Prostate 2018; 78:469-475. [PMID: 29460290 DOI: 10.1002/pros.23491] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/23/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess the effect of pelvic lymph node dissection (PLND) extent on cancer-specific mortality (CSM) in prostate cancer (PCa) patients without lymph node invasion (LNI) treated with radical prostatectomy (RP). METHODS Within the Surveillance, Epidemiology, and End results (SEER) database (2004-2014), we identified patients with D'Amico intermediate- or high-risk characteristics who underwent RP with PLND, without evidence of LNI. First, multivariable logistic regression models tested for predictors of more extensive PLND, defined as removed lymph node count (NRN) ≥75th percentile. Second, Kaplan-Meier analyses and multivariable Cox regression models tested the effect of NRN ≥75th percentile on CSM. Finally, survival analyses were repeated using continuously coded NRN. RESULTS In 28 147 RP and PLND patients without LNI, 67.3% versus 32.7% exhibited D'Amico intermediate- or high-risk characteristics. The median NRN was 6 (IQR 3-10), the 75th percentile defined patients with NRN ≥11. Patients with NRN ≥11 had higher rate of cT2/3 stage (29.8 vs 26.1%), GS ≥8 (25.7 vs 22.4%), and respectively more frequently exhibited D'Amico high-risk characteristics (34.6 vs 32.1%). In multivariable logistic regression models predicting the probability of more extensive PLND (NRN ≥11), higher biopsy GS, higher cT stage, higher PSA, more recent year of diagnosis, and younger age at diagnosis represented independent predictors. At 72 months after RP, CSM-free rates were 99.5 versus 98.1% for NRN ≥11 and NRN ≤10, respectively and resulted in a HR of 0.50 (P = 0.01), after adjustment for all covariates. Similarly, continuously coded NRN achieved independent predictor status (HR: 0.955, P = 0.01), where each additional removed lymph node reduced CSM risk by 4.5%. CONCLUSION More extensive PLND at RP provides improved staging information and consequently is associated with lower CSM in D'Amico intermediate- and high-risk PCa patients without evidence of LNI. Hence, more extensive PLND should be recommended in such individuals.
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Affiliation(s)
- Felix Preisser
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Marco Bandini
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Marchioni
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy
| | - Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Raisa S Pompe
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Nicola Fossati
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | | | - Hans Heinzer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
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Aljubran A, Abusamra A, Alkhateeb S, Alotaibi M, Rabah D, Bazarbashi S, Alkushi H, Al-Mansour M, Alharbi H, Eltijani A, Alghamdi A, Alsharm A, Ahmad I, Murshid E. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for prostate cancer 2017. Urol Ann 2018. [PMID: 29719323 DOI: 10.4103/ua.ua-177-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This is an update to the previously published Saudi guidelines for the evaluation and medical and surgical management of patients diagnosed with prostate cancer. Prostate cancer is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The guidelines are presented with supporting evidence levels based on a comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Local factors, such as availability, logistic feasibility, and familiarity of various treatment modalities, have been taken into consideration. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health-care policymakers in the management of patients diagnosed with adenocarcinoma of the prostate.
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Affiliation(s)
- Ali Aljubran
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ashraf Abusamra
- Department of Surgery, Urology Section, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Dammam, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-Oncology Research Chair, King Saud University, Dammam, Saudi Arabia
| | - Shouki Bazarbashi
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hussain Alkushi
- Department of Pathology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mubarak Al-Mansour
- Department of Oncology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hulayel Alharbi
- Department of Medical Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Amin Eltijani
- Department of Oncology, Division of Medical Oncology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Suh C, Shinagare A, Westenfield A, Ramaiya N, Van den Abbeele A, Kim K. Yield of bone scintigraphy for the detection of metastatic disease in treatment-naive prostate cancer: a systematic review and meta-analysis. Clin Radiol 2018; 73:158-167. [DOI: 10.1016/j.crad.2017.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 07/24/2017] [Accepted: 08/04/2017] [Indexed: 01/23/2023]
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Aljubran A, Abusamra A, Alkhateeb S, Alotaibi M, Rabah D, Bazarbashi S, Alkushi H, Al-Mansour M, Alharbi H, Eltijani A, Alghamdi A, Alsharm A, Ahmad I, Murshid E. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for prostate cancer 2017. Urol Ann 2018; 10:138-145. [PMID: 29719323 PMCID: PMC5907320 DOI: 10.4103/ua.ua_177_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This is an update to the previously published Saudi guidelines for the evaluation and medical and surgical management of patients diagnosed with prostate cancer. Prostate cancer is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The guidelines are presented with supporting evidence levels based on a comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Local factors, such as availability, logistic feasibility, and familiarity of various treatment modalities, have been taken into consideration. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health-care policymakers in the management of patients diagnosed with adenocarcinoma of the prostate.
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Affiliation(s)
- Ali Aljubran
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ashraf Abusamra
- Department of Surgery, Urology Section, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Dammam, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-Oncology Research Chair, King Saud University, Dammam, Saudi Arabia
| | - Shouki Bazarbashi
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hussain Alkushi
- Department of Pathology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mubarak Al-Mansour
- Department of Oncology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hulayel Alharbi
- Department of Medical Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Amin Eltijani
- Department of Oncology, Division of Medical Oncology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Chien TM, Lu YM, Geng JH, Huang TY, Ke HL, Huang CN, Li CC, Chou YH, Wu WJ, Huang SP. Predictors of Positive Bone Metastasis in Newly Diagnosed Prostate Cancer Patients. Asian Pac J Cancer Prev 2017; 17:1187-91. [PMID: 27039746 DOI: 10.7314/apjcp.2016.17.3.1187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of prostate cancer (PCa) has been increasing in recent years. Treatment strategies are largely based on the results of bone scan screening. Therefore, our aim was to investigate predictors of positive bone metastasis in newly diagnosed PCa patients. MATERIALS AND METHODS After extensive review, 336 consecutive patients newly diagnosed with PCa between April 2010 and November 2013 at our institution were enlisted in the study. Patients were divided into two groups according to bone scan results. Univariate analyses (Chi-square test for discrete variables and independent t-test for continuous variables) were applied to determine the potentially significant risk factors associated with distant bone metastasis. Binary logistic regression analyses were used to further investigate the influence of these factors on bone metastasis. RESULTS The patient mean age was 71.9 ± 8.6 years (range: 48 to 94 years). The mean prostate specific antigen (PSA) level and biopsy Gleason score were 260.2 ± 1107.8 ng/mL and 7.4 ± 1.5, respectively. The body mass index (BMI) for the series was 24.5 ± 3.4 kg/m2. Sixty-four patients (19.0%) had a positive bone scan result. Patients with positive bone scan results had a significantly lower BMI (23.3 ± 3.5 vs. 24.8 ± 3.3; p=0.003), a higher Gleason score (8.5 ± 1.1 vs. 7.1 ± 1.5; p < 0.001), and a higher PSA level (1071.3 ± 2337.1 vs. 69.4 ± 235.5; p < 0.001) than those without bone metastasis. Multivariate logistic regression analysis employing the above independent predictors demonstrated that a Gleason score of ≥7, clinical stage ≥T3, BMI ≤22 kg/m2, and an initial PSA level of ≥20 ng/mL were all independent predictors of bone metastasis. CONCLUSIONS A bone scan might be necessary in newly diagnosed PCa patients with any of the following criteria: clinical stage T3 or higher, a Gleason score of 7 or higher, BMI equal to or less than 22, and a PSA level of 20 or higher.
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Affiliation(s)
- Tsu-Ming Chien
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan E-mail :
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Unexplained Bone Pain Is an Independent Risk Factor for Bone Metastases in Newly Diagnosed Prostate Cancer: A Prospective Study. Urology 2017; 99:148-154. [DOI: 10.1016/j.urology.2016.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/29/2016] [Accepted: 09/10/2016] [Indexed: 11/22/2022]
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20
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Miah S, Ahmed HU, Freeman A, Emberton M. Does true Gleason pattern 3 merit its cancer descriptor? Nat Rev Urol 2016; 13:541-8. [DOI: 10.1038/nrurol.2016.141] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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21
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Pyka T, Okamoto S, Dahlbender M, Tauber R, Retz M, Heck M, Tamaki N, Schwaiger M, Maurer T, Eiber M. Comparison of bone scintigraphy and 68Ga-PSMA PET for skeletal staging in prostate cancer. Eur J Nucl Med Mol Imaging 2016; 43:2114-2121. [PMID: 27290607 DOI: 10.1007/s00259-016-3435-0] [Citation(s) in RCA: 256] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 06/02/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of our study was to compare the diagnostic performance of 68Ga-PSMA PET and 99mTc bone scintigraphy (BS) for the detection of bone metastases in prostate cancer (PC) patients. METHODS One hundred twenty-six patients who received planar BS and PSMA PET within three months and without change of therapy were extracted from our database. Bone lesions were categorized into benign, metastatic, or equivocal by two experienced observers. A best valuable comparator (BVC) was defined based on BS, PET, additional imaging, and follow-up data. The cohort was further divided into clinical subgroups (primary staging, biochemical recurrence, and metastatic castration-resistant prostate cancer [mCRPC]). Additionally, subgroups of patients with less than 30 days delay between the two imaging procedures and with additional single-photon emission computed tomography (SPECT) were analyzed. RESULTS A total of 75 of 126 patients were diagnosed with bone metastases. Sensitivities and specificities regarding overall bone involvement were 98.7-100 % and 88.2-100 % for PET, and 86.7-89.3 % and 60.8-96.1 % (p < 0.001) for BS, with ranges representing results for 'optimistic' or 'pessimistic' classification of equivocal lesions. Out of 1115 examined bone regions, 410 showed metastases. Region-based analysis revealed a sensitivity and specificity of 98.8-99.0 % and 98.9-100 % for PET, and 82.4-86.6 % and 91.6-97.9 % (p < 0.001) for BS, respectively. PSMA PET also performed better in all subgroups, except patient-based analysis in mCRPC. CONCLUSION Ga-PSMA PET outperforms planar BS for the detection of affected bone regions as well as determination of overall bone involvement in PC patients. Our results indicate that BS in patients who have received PSMA PET for staging only rarely offers additional information; however, prospective studies, including a standardized integrated x-ray computed tomography (SPECT/CT) protocol, should be performed in order to confirm the presented results.
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Affiliation(s)
- Thomas Pyka
- Department of Nuclear Medicine, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Shozo Okamoto
- Department of Nuclear Medicine, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Robert Tauber
- Department of Urology, Klinikum rechts der Isar der TU München, Munich, Germany
| | - Margitta Retz
- Department of Urology, Klinikum rechts der Isar der TU München, Munich, Germany
| | - Matthias Heck
- Department of Urology, Klinikum rechts der Isar der TU München, Munich, Germany
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Klinikum rechts der Isar der TU München, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, Munich, Germany
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22
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Abusamra A, Murshid E, Kushi H, Alkhateeb S, Al-Mansour M, Saadeddin A, Rabah D, Bazarbashi S, Alotaibi M, Alghamdi A, Alghamdi K, Alsharm A, Ahmad I. Saudi oncology society and Saudi urology association combined clinical management guidelines for prostate cancer. Urol Ann 2016; 8:123-30. [PMID: 27141178 PMCID: PMC4839225 DOI: 10.4103/0974-7796.176872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 11/15/2015] [Indexed: 02/05/2023] Open
Abstract
This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with prostate cancer. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7(th) edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi oncology society and Saudi urological association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with adenocarcinoma of the prostate to.
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Affiliation(s)
- Ashraf Abusamra
- Department of Surgery, Urology Section, King Khalid Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Medical Military City, Riyadh, Saudi Arabia
| | - Hussain Kushi
- Department of Radiation Oncology, Princess Norah Oncology Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mubarak Al-Mansour
- Department of Oncology, King Abdulaziz Medical City and King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ahmad Saadeddin
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-Oncology Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Department of Oncology, Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Medical Military Center, Riyadh, Saudi Arabia
| | - Khalid Alghamdi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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23
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Tang V, Murphy DG, Moon D. Management of Locally Advanced (Nonmetastatic) Prostate Cancer. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00051-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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24
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Paterson C, Alashkham A, Windsor P, Nabi G. Management and treatment of men affected by metastatic prostate cancer: evidence-based recommendations for practice. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2015. [DOI: 10.1111/ijun.12093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Catherine Paterson
- Research Fellow in Cancer Care, Academic section of Urology, Medical Research Institute, School of Medicine; University of Dundee; UK
| | - Abduelmenem Alashkham
- Academic section of Urology, Medical Research Institute, School of Medicine; University of Dundee; UK
| | - Phyllis Windsor
- OBE-Consultant Clinical Oncologist; Ninewells Hospital; Dundee UK
| | - Ghulam Nabi
- [Urol]-Reader in Surgical Uro-Oncology, Hon. Consultant Urological Surgeon; University of Dundee; UK
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25
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Özgür BC, Gültekin S, Ekici M, Yılmazer D, Alper M. A narrowing range of bone scan in newly diagnosed prostate cancer patients: A retrospective comparative study. Urol Ann 2015; 7:193-8. [PMID: 25835063 PMCID: PMC4374258 DOI: 10.4103/0974-7796.150479] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 03/01/2014] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The objective of the following study is to clarify a suitable group whereby a bone scan could be spared at the initial staging of prostate cancer, we wished to identify the possible relationship between bone metastasis and clinical and pathological parameters including serum total prostate specific antigen (PSA) concentration, alkaline phosphatase (ALP), biopsy Gleason Score (GS), and percentage of pathological cores. MATERIALS AND METHODS We reviewed the results of 220 bone scintigraphies, which were done between January 1, 2011 and June 30, 2013 in patients with newly diagnosed prostate cancer. These parameters were evaluated together with standard clinicopathological data to determine the prediction ability of the bone scan by univariate and multivariate analyses. RESULTS Bone metastases were seen in 44 patients of all 220 patients (20%, 95% confidence interval, 17-24%). In univariate analysis, PSA and biopsy GS were useful in predicting the bone scan result, but ALP and percentage of pathological cores was not. In multivariate analysis, the single most useful parameter in predicting the bone scan result was PSA (P < 0.001). CONCLUSIONS A bone scan seems to be impractical in newly diagnosed prostate cancer patients with serum PSA level <20 ng/ml and GS up to seven and pre-treatment PSA is the best predictor of the need for the bone scan according to results of this study.
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Affiliation(s)
- Berat Cem Özgür
- Department of Urology, Ankara Research and Training Hospital, Ankara, Turkey
| | - Sinan Gültekin
- Department of Nuclear Medicine, Ankara Dışkapı Research and Training Hospital, Ankara, Turkey
| | - Musa Ekici
- Department of Urology, Ankara Dışkapı Research and Training Hospital, Ankara, Turkey
| | - Demet Yılmazer
- Department of Pathology, Ankara Dışkapı Research and Training Hospital, Ankara, Turkey
| | - Murat Alper
- Department of Pathology, Ankara Dışkapı Research and Training Hospital, Ankara, Turkey
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26
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Alkhateeb S, Abusamra A, Rabah D, Alotaibi M, Mahmood R, Almansour M, Murshid E, Alsharm A, Alolayan A, Ahmad I, Alkushi H, Alghamdi A, Bazarbashi S. Saudi oncology society and Saudi urology association combined clinical management guidelines for prostate cancer. Urol Ann 2014; 6:278-85. [PMID: 25371601 PMCID: PMC4216530 DOI: 10.4103/0974-7796.140959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 02/05/2023] Open
Abstract
In this report, updated guidelines for the evaluation, medical, and surgical management of prostate cancer are presented. They are categorized according the stage of the disease using the tumor node metastasis staging system 7(th) edition. The recommendations are presented with supporting evidence level.
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Affiliation(s)
- Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City-Riyadh, Saudi Arabia
| | - Ashraf Abusamra
- Section of Urology, Department of Surgery, King Khaled Hospital, King Abdulaziz Medical City-Jeddah, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, Division of Urology, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- Princess Al Johora Al-Ibrahim Centre for Cancer Research (Uro-Oncology Research Chair), King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Rana Mahmood
- Section of Radiation Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mubarak Almansour
- Oncology department, Princess Noura Oncology Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alsharm
- Department of Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ashwaq Alolayan
- Department of Oncology, King Abdulaziz Medical City-Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Hussain Alkushi
- Oncology department, Princess Noura Oncology Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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27
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Kim L, Min M, Roos D, Nguyen L, Yeoh E. Are staging investigations being overused in patients with low and intermediate risk prostate cancer? J Med Imaging Radiat Oncol 2014; 59:77-81. [DOI: 10.1111/1754-9485.12234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Laurence Kim
- Department of Radiation Oncology; Royal Adelaide Hospital; South Australia Australia
| | - Myo Min
- Department of Radiation Oncology; Royal Adelaide Hospital; South Australia Australia
| | - Daniel Roos
- Department of Radiation Oncology; Royal Adelaide Hospital; South Australia Australia
- School of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Luom Nguyen
- Department of Radiation Oncology; Royal Adelaide Hospital; South Australia Australia
| | - Eric Yeoh
- Department of Radiation Oncology; Royal Adelaide Hospital; South Australia Australia
- School of Medicine; University of Adelaide; Adelaide South Australia Australia
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28
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Merdan S, Womble PR, Miller DC, Barnett C, Ye Z, Linsell SM, Montie JE, Denton BT. Toward better use of bone scans among men with early-stage prostate cancer. Urology 2014; 84:793-8. [PMID: 25096341 DOI: 10.1016/j.urology.2014.06.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/20/2014] [Accepted: 06/06/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the performance of published guidelines compared with that of current practice for radiographic staging of men with newly diagnosed prostate cancer. MATERIALS AND METHODS Using data from the Michigan Urological Surgery Improvement Collaborative clinical registry, we identified 1509 men diagnosed with prostate cancer from March 2012 through June 2013. Clinical data included age, prostate-specific antigen (PSA) level, Gleason score (GS), clinical trial stage, number of biopsy cores, and bone scan (BS) results. We then fit a multivariate logistic regression model to examine the association between clinical variables and the occurrence of bone metastases. Because some patients did not undergo BS, we used established methods to correct for verification bias and estimate the diagnostic accuracy of published guidelines. RESULTS Among 416 men who received a BS, 48 (11.5%) had evidence of bone metastases. Patients with bone metastases were older, with higher PSA levels and GS (all P <.05). In multivariate analyses, PSA (P <.001) and GS (P = .004) were the only independent predictors of positive BS. Guidelines from the American Urological Association and the National Comprehensive Cancer Network demonstrated similar performance in detecting bone metastases in our population, with fewer negative study results than those of the European Association of Urology guideline. Applying the American Urological Association recommendations (ie, image when PSA level >20 ng/mL or GS ≥ 8) to current clinical practice, we estimate that <1% of positive study results would be missed, whereas the number of negative study results would be reduced by 38%. CONCLUSION Based on current practice patterns, more uniform application of existing guidelines would ensure that BS is performed for almost all men with bone metastases, while avoiding many negative imaging studies.
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Affiliation(s)
- Selin Merdan
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI
| | - Paul R Womble
- Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI
| | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI
| | - Christine Barnett
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI
| | - Zaojun Ye
- Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI
| | - Susan M Linsell
- Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI
| | - James E Montie
- Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI
| | - Brian T Denton
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI.
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Abstract
Imaging plays a central role in the detection, diagnosis, staging, and follow-up of prostate carcinoma. This article discusses the role of multiple imaging modalities in the diagnosis and staging of prostate cancer, with attention to imaging features of localized and metastatic disease, imaging adjuncts to improve prostate biopsy, and potential imaging biomarkers. In addition, the role of imaging in the management of prostate cancer, with emphasis on surveillance, evaluation of response to new therapies, and detection of recurrent disease is described. Lastly, future directions in prostate cancer imaging are presented.
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30
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Prospective Multicenter Study of Bone Scintigraphy in Consecutive Patients With Newly Diagnosed Prostate Cancer. Clin Nucl Med 2014; 39:26-31. [DOI: 10.1097/rlu.0000000000000291] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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31
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Kluth LA, Xylinas E, Rieken M, Chun FKH, Fajkovic H, Becker A, Karakiewicz PI, Passoni N, Herman M, Lotan Y, Seitz C, Schramek P, Remzi M, Loidl W, Guillonneau B, Rouprêt M, Briganti A, Scherr DS, Graefen M, Tewari AK, Shariat SF. Does increasing the nodal yield improve outcomes in contemporary patients without nodal metastasis undergoing radical prostatectomy? Urol Oncol 2013; 32:47.e1-8. [PMID: 24055425 DOI: 10.1016/j.urolonc.2013.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 06/22/2013] [Accepted: 06/24/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine if the number of lymph nodes (LNs) removed is an independent predictor of biochemical recurrence (BCR) in patients without LN metastases undergoing radical prostatectomy (RP). MATERIAL AND METHODS Retrospective analysis of 7,310 patients treated at 7 centers with RP and pelvic LN dissection for clinically localized prostate cancer between 2000 and 2011. Patients with LN metastases (n = 398) and other reasons (stated later in the article) (n = 372) were excluded, which left 6,540 patients for the final analyses. RESULTS Overall, median biopsy and RP Gleason score were both 7; median prostate specific antigen level was 6 ng/ml (interquartile range [IQR]: 5); and median number of LNs removed was 6 (IQR: 8). A total of 3,698 (57%), 2,064 (32%), and 508 (8%) patients had ≥ 6, ≥ 10, and ≥ 20 LNs removed, respectively. Patients with more LNs removed were older, had a higher prostate specific antigen level, had higher clinical and pathologic T stage, and had higher RP Gleason score (all P<0.002). Within a median follow-up of 21 (IQR: 16) months, more LNs removed was associated with an increased risk of BCR (continuous: P = 0.021; categorical: P = 0.014). In multivariable analyses that adjusted for the effects of standard clinicopathologic factors, none of the nodal stratifications predicted BCR. CONCLUSIONS The number of LNs did not have any prognostic significance in our contemporary cohort of patients with LN-negative prostate cancer. This suggests that the risk of missed clinically significant micrometastasis may be minimal in patients currently treated with RP and having a lower LN yield.
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Affiliation(s)
- Luis A Kluth
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evanguelos Xylinas
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - Malte Rieken
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, University Hospital of Basel, Basel, Switzerland
| | - Felix K-H Chun
- Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harun Fajkovic
- Department of Urology, Landesklinikum St.Poelten, Sankt Poelten, Austria
| | - Andreas Becker
- Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | | | - Michael Herman
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Paul Schramek
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Mesut Remzi
- Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria
| | - Wolfgang Loidl
- Prostate cancer center, Krankenhaus Barmherzige Schwestern Linz, Linz, Austria
| | | | - Morgan Rouprêt
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Academic Department of Urology of la Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, University Paris VI, Faculté de médicine Pierre et Marie Curie, Paris, France
| | | | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Markus Graefen
- Prostate cancer center, Martini-Clinic, Hamburg, Germany
| | - Ashutosh K Tewari
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Shahrokh F Shariat
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Division of Medical Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, Medical University of Vienna, Vienna, Austria.
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Kamaleshwaran KK, Mittal BR, Harisankar CNB, Bhattacharya A, Singh SK, Mandal AK. Predictive value of serum prostate specific antigen in detecting bone metastasis in prostate cancer patients using bone scintigraphy. Indian J Nucl Med 2013; 27:81-4. [PMID: 23723577 PMCID: PMC3665151 DOI: 10.4103/0972-3919.110683] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Radionuclide bone scan (BS) used to be the investigation of choice for detecting osseous metastases in prostate cancer. Now, with the availability serum prostate specific antigen (PSA) testing, clinicians do have a timely, cost-effective method to determine those patients who are highly unlikely to have osseous metastases. We determine the utility of PSA for predicting the presence of skeletal metastasis on BSs in prostate cancer patients. Materials and Methods: Retrospective analysis of medical records of 322 consecutive prostate cancers patients subjected to BS during the last 3 years was done. 52 cases were excluded due to following reasons: Serum PSA not available, hormonal or other therapy given prior to serum PSA measurement, and/or BS, and symptomatic for bone metastasis. In remaining 270 cases, PSA value and BS were evaluated. BS was performed with Tc99m methylene diphosphonate (MDP) as per the standard protocol. Results: BS was found to be positive in 153/270 (56%) and negative in 117 (46%) patients. Of the 153 positive cases, 108 (70%) had serum PSA > 100 ng/ml, 42 (28%) had PSA of 20-100 ng/ml and only 3 (2%) had PSA < 20 ng/ml. All the patients with PSA > 100 ng/ml had multiple skeletal metastasis. Of the 117 negative cases, 110 (94%) had a PSA < 20 ng/ml, 5 had between 20 and 100 ng/ml and only 2 (1.8%) had PSA > 100 ng/ml. Of the 113 patients with serum PSA < 20 ng/ml, 110 (97.4%) did not show any bony metastasis. 150/157 (95.5%) patients with PSA > 20 ng/ml had bone metastasis. Using this criterion, 110 (40.7%) scans would have been omitted. Conclusions: Serum PSA < 20 ng/ml have high predictive value in ruling out skeletal metastasis. Our data are in corroboration with results from previous studies that BS should be performed only if PSA > 20 ng/ml. Using this cut-off, unnecessary investigation can be avoided. Avoiding BS in this group of patients would translate into a significant cost-saving and reduction in their psychological and physical burden.
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Ho CCK, Seong PK, Zainuddin ZM, Abdul Manaf MR, Parameswaran M, Razack AH. Retrospective Study of Predictors of Bone Metastasis in Prostate Cancer Cases. Asian Pac J Cancer Prev 2013; 14:3289-92. [DOI: 10.7314/apjcp.2013.14.5.3289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lim SK, Kim KH, Shin TY, Chung BH, Hong SJ, Choi YD, Rha KH. Gleason 5+4 Has Worse Oncological and Pathological Outcomes Compared with Gleason 4+5: Significance of Gleason 5 Pattern. Ann Surg Oncol 2013; 20:3127-32. [DOI: 10.1245/s10434-013-2996-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Indexed: 11/18/2022]
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Damle NA, Bal C, Bandopadhyaya GP, Kumar L, Kumar P, Malhotra A, Lata S. The role of 18F-fluoride PET-CT in the detection of bone metastases in patients with breast, lung and prostate carcinoma: a comparison with FDG PET/CT and 99mTc-MDP bone scan. Jpn J Radiol 2013; 31:262-9. [PMID: 23377765 DOI: 10.1007/s11604-013-0179-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 01/06/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We aimed to compare the role of (18)F-fluoride PET/CT, FDG PET/CT and (99m)Tc-MDP bone scans in the detection of bone metastases in patients with lung, breast and prostate carcinoma. METHODS This was a prospective study including patients for staging (S) and restaging (R). Seventy-two patients (23S, 49R) with infiltrating ductal breast carcinoma, 49 patients (25S, 24R) with prostate adenocarcinoma and 30 patients (17S, 13R) with non-small-cell lung carcinoma (NSCLC), without known bone metastases but with high risk/clinical suspicion for the same, underwent a (99m)Tc-MDP bone scan, FDG PET/CT and (18)F-fluoride PET/CT within 2 weeks. All scans were reviewed by two experienced nuclear medicine physicians, and the findings were correlated with MRI/thin-slice CT/skeletal survey. Histological verification was done wherever feasible. RESULTS Sensitivity and negative predictive value (NPV) of (18)F-fluoride PET/CT was 100 % in all three malignancies, while that of FDG PET/CT was 79 % and 73 % in NSCLC, 73 % and 80 % in breast cancer and 72 and 65 % in prostate cancer. Specificity and positive predictive value (PPV) of FDG PET/CT were 100 % in NSCLC and prostate and 97 % and 96 % in breast cancer. As compared to the (99m)Tc-MDP bone scan, all parameters were superior for (18)F-fluoride PET/CT in prostate and breast cancer, but sensitivity and NPV were equal in NSCLC. The MDP bone scan had superior sensitivity and NPV compared to FDG PET/CT but had low specificity and PPV. CONCLUSION To rule out bone metastases in cases where there is a high index of suspicion, (18)F-fluoride PET/CT is the most reliable investigation. (18)F-fluoride PET/CT has the potential to replace the (99m)Tc-MDP bone scan for the detection of bone metastases.
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Affiliation(s)
- Nishikant Avinash Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Room no. 59 A, New Delhi, 110029, India.
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Aglamis E, Tasdemir C, Ceylan C. The role of National Institutes of Health category IV prostatitis in accurately staging the newly diagnosed prostate cancer. Ir J Med Sci 2013; 182:463-7. [DOI: 10.1007/s11845-013-0914-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/19/2013] [Indexed: 10/27/2022]
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Whole-body diffusion-weighted MRI compared with (18)F-NaF PET/CT for detection of bone metastases in patients with high-risk prostate carcinoma. AJR Am J Roentgenol 2013; 199:1114-20. [PMID: 23096187 DOI: 10.2214/ajr.11.8351] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the accuracy of whole-body diffusion-weighted MRI (DWI) and (18)F-NaF PET/CT for detection of bone metastases in patients with high-risk prostate cancer. SUBJECTS AND METHODS Both patient- and lesion-based analyses were performed on 49 consecutive patients (median age, 67 years; age range, 57-80 years) with recently diagnosed high-risk prostate cancer. All patients underwent bone scintigraphy, whole-body MRI including DWI and (18)F-NaF PET/CT before treatment. Bone scintigraphy, conventional MR images, and follow-up images were used as the standard of reference to evaluate (18)F-NaF PET/CT and DWI. RESULTS On patient-based analysis, five patients had skeletal metastases on reference imaging that both DWI and (18)F-NaF PET/CT could verify, and (18)F-NaF PET/CT and DWI showed false-positive findings in four and one patient, respectively. With lesion-based analysis, (18)F-NaF PET/CT and DWI showed nine and five true-positive lesions, zero and four false-negative lesions, and seven and two false-positive lesions, respectively. Two patients with uncountable bone metastases were analyzed separately. In these patients, (18)F-NaF PET/CT showed more bone metastases than did DWI. CONCLUSION We believe (18)F-NaF PET/CT is a sensitive modality for detection of bone metastases caused by prostate cancer. Whole-body DWI shows a higher specificity but lower sensitivity than (18)F-NaF PET/CT. Future studies with a larger patient cohort along with analyses of costs and clinical availability are needed before implementation of these methods can be considered.
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Carmona Echeverria LM, Drudge-Coates L, Wilkins CJ, Muir GH. Bone scan is of doubtful value as a first staging test in the primary presentation of prostate cancer. ISRN ONCOLOGY 2012; 2012:585017. [PMID: 23209943 PMCID: PMC3503315 DOI: 10.5402/2012/585017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 09/24/2012] [Indexed: 11/23/2022]
Abstract
Purpose. To determine whether axial MR imaging could replace bone scan as the primary staging test in newly diagnosed CaP. Material and Methods. We reviewed retrospectively all bone scans (n = 1201) performed in newly diagnosed CaP patients from 2000 to 2010 in a single tertiary academic center. We recorded patient age, ethnicity, PSA at diagnosis, TNM stage, Gleason score, alkaline phosphatase, bone scan results and axial imaging if available. Results. Mean patient age was 72 years (41–96), mean PSA and alkaline phosphatase were 268.9 ng/mL and 166 IU/L, respectively. Patients were divided in four groups according to possible bony metastases on bone scan. Group 1: Negative, no metastases demonstrated. Group 2: Positive, metastases only in pelvis and/or lumbar spine. Group 3: Positive, widespread metastases including pelvis and lumbar spine. Group 4: Positive, distant metastases without pelvic or lumbar spine abnormalities. Group 4 patients were analyzed in detail, two had possible disease that was detected only outside the pelvic and lumbar spine, unfortunately follow up images were insufficient to confirm the nature of the lesions. Conclusions. Although bone scan is a useful investigation to confirm and monitor metastasic CaP, our data suggests that axial MR imaging is an adequate primary staging study in untreated disease. Bone scan is unnecessary if CT or MRI of the pelvis and abdomen are clear of metastases.
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Affiliation(s)
- Lina M Carmona Echeverria
- Department of Urology, King's College Hospital, 2nd floor Hambleden Wing, Denmark Hill, London SE19 2BY, UK
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Janane A, Jawad C, Hajji F, Ould T, Ghadouane M, Ameur A, Abbar M, Albouzidi A. [Bone scan findings in a North African ethnic group and relation to PSA level and Gleason score of the biopsy]. Actas Urol Esp 2011; 35:534-9. [PMID: 21664008 DOI: 10.1016/j.acuro.2011.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 03/11/2011] [Indexed: 10/26/2022]
Abstract
OBJECTIVE A number of large-scaled studies carried out in western countries have proven a positive relationship between serum prostate specific antigen (PSA) level and prevalence of positive bone scan findings, in newly diagnosed prostate cancer patients. The aim of our study is to verify that the tendency occurs as well in north-african population, as well as to establish a possible correlation between PSA level, bone scan result, and Gleason score. MATERIAL AND METHODS Records of 348 patients diagnosed to have prostatic adenocarcinoma were reviewed retrospectively for bone scan results, PSA levels, and Gleason score. Statistical analyses were performed using the Fisher exact test, by a statistical software (statistical package for the social sciences "SPSS", version 11.5.1, Chicago, IL) with differences at P<0,05 considered significant. RESULTS Based on positive bone scintigraphy 102 patients were proven to have bone metastases. None of these patients had a PSA level of less than 10 ng/ml. Six metastatic patients had PSA level between 11 and 20 ng/ml. 45 metastatic cases had serum PSA between 21 and 100. Concerning PSA level over 101 ng/ml, 51 men had positive bone scan. CONCLUSION Based on the PSA level, the likelihood of positive bone scan result can be postulated. According to PSA levels, staging investigations can be more selective for our patients. The risk of positive bone scan is so low that it is not required for patients with PSA level less than 10 ng/ml. On the other hand, on studying the correlation between Gleason score and PSA level or bone scan results, no statistically significant relationship was established.
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Al-Ghazo MA, Ghalayini IF, Al-Azab RS, Bani-Hani I, Barham A, Haddad Y. Do all patients with newly diagnosed prostate cancer need staging radionuclide bone scan? A retrospective study. Int Braz J Urol 2011; 36:685-91; discussion 691-2. [PMID: 21176275 DOI: 10.1590/s1677-55382010000600006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Define a group of patients with newly diagnosed prostate cancer, whose risk of bone metastasis is low enough to omit a bone scan staging study. MATERIALS AND METHODS From 2003 to 2009, the medical records of patients who were newly diagnosed with prostate cancer were retrospectively reviewed. The data collected included: age, digital rectal examination, serum prostate specific antigen (PSA), Gleason score, clinical T stage, and bone isotope scan. Patients were divided into two groups according to the results of bone isotope scan; positive group and negative group. A univariate and multivariate binary logistic regression was used to analyze the results. RESULTS Of the 106 patients, 98 had a complete data collection and were entered into the study. The median age of the patients was 70.5 years and patients with a positive bone scan was 74 years, significantly higher than for patients with negative scans (69 years) (p=0.02). Bone metastasis was detected in 39 cases (39.7%). In all patients with clinical T1-2 stage, a Gleason score of <8 and PSA≤20 ng/mL, the bone isotope scans were negative. In univariate analysis, PSA (>20 ng/mL) and Gleason score (>7) were independently predictive of positive bone scan, while clinical stage was not. CONCLUSION Staging bone scans can be omitted in patients with a PSA level of ≤20 ng/mL, and Gleason score<8. Our results suggest that by considering the Gleason score and PSA, a larger proportion of patients with prostate cancer could avoid a staging bone scan.
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Affiliation(s)
- Mohammed A Al-Ghazo
- Department of General Surgery and Urology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan.
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Tanaka N, Fujimoto K, Shinkai T, Nakai Y, Kuwada M, Anai S, Miyake M, Hirayama A, Hasegawa M, Hirao Y. Bone scan can be spared in asymptomatic prostate cancer patients with PSA of <=20 ng/ml and Gleason score of <=6 at the initial stage of diagnosis. Jpn J Clin Oncol 2011; 41:1209-13. [PMID: 21862505 DOI: 10.1093/jjco/hyr118] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE According to several guidelines, it is acceptable to spare a bone scan in the patients who are newly diagnosed with low-risk prostate cancer. Our aim is to clarify a suitable group whereby a bone scan could be spared at the initial staging of prostate cancer. METHODS Consecutive 857 patients who were newly diagnosed from 2004 through 2009 and received bone scans using technetium 99m methylene diphosphonate at the initial staging were enrolled. The proportion of positive bone metastases by age distribution, prostate-specific antigen level at diagnosis, Gleason score and clinical T stage were evaluated. Univariate and multivariate logistic regression analyses were performed to identify the predictors of positive bone metastases. RESULTS Of all 857 patients, 40 patients (4.7%) showed bone metastases. Patients with higher age, prostate-specific antigen level, clinical stage and Gleason score showed significantly higher rate of bone metastases (P < 0.001). In univariate logistic regression analyses, age, prostate-specific antigen level, clinical stage and Gleason score were independent predictors of bone metastasis. The multivariate analysis showed that both the prostate-specific antigen level >50 ng/ml and the Gleason score ≥4 + 3 were independent predictors of bone metastases. CONCLUSIONS The incidences of bone metastases in patients with a prostate-specific antigen level of ≤20 ng/ml and Gleason score of ≤6 were reasonably low. Collectively, a bone scan is not necessary as a routine examination for these patients at their initial staging of prostate cancer.
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Affiliation(s)
- Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
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Tolonen TT, Tammela TL, Kujala PM, Tuominen VJ, Isola JJ, Visakorpi T. Histopathological variables and biomarkers enhancer of zeste homologue 2, Ki-67 and minichromosome maintenance protein 7 as prognosticators in primarily endocrine-treated prostate cancer. BJU Int 2011; 108:1430-8. [DOI: 10.1111/j.1464-410x.2011.10253.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abusamra AJ, Bazarbashi S, Bahader Y, Kushi H, Rabbah D, Al Bogami N, Al Ghamdi K, Al Ghamdi A, Balaraj K, Seyam R, Al Otaibi M, Al Saeed E. Saudi Oncology Society clinical management guidelines for prostate cancer. Urol Ann 2011; 3 Suppl:S10-6. [PMID: 21673847 PMCID: PMC3099482 DOI: 10.4103/0974-7796.78550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In this report, guidelines for the evaluation, medical and surgical management of testicular germ cell tumors is presented. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7th edition. The recommendations are presented with supporting level of evidence.
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Affiliation(s)
- Ashraf J Abusamra
- Departments of Surgery and Oncology, King Abdul-Aziz Medical City, Jeddah, Saudi Arabian National Guard Health Affairs, Jeddah, Saudi Arabia
- Address for correspondence: Dr. Ashraf Abusamra, Consultant of Urology and Oncology, Divisions of Urology & Oncology, Departments of Surgery & Oncology, King Abdul-Aziz Medical City, Jeddah, Saudi Arabian National Guard Health Affairs, Jeddah, Saudi Arabia. E-mail:
| | - Shouki Bazarbashi
- Departments of Surgery and Oncology, King Abdul-Aziz Medical City, Jeddah, Saudi Arabian National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Yasser Bahader
- Departments of Surgery and Oncology, King Abdul-Aziz Medical City, Jeddah, Saudi Arabian National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Hussain Kushi
- Departments of Surgery and Oncology, King Abdul-Aziz Medical City, Jeddah, Saudi Arabian National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Dany Rabbah
- Departments of Surgery and Oncology, King Abdul-Aziz Medical City, Jeddah, Saudi Arabian National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Naser Al Bogami
- Departments of Surgery and Oncology, King Abdul-Aziz Medical City, Jeddah, Saudi Arabian National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Khalid Al Ghamdi
- Departments of Surgery and Oncology, King Abdul-Aziz Medical City, Jeddah, Saudi Arabian National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Abdullah Al Ghamdi
- Departments of Surgery and Oncology, King Abdul-Aziz Medical City, Jeddah, Saudi Arabian National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Khaled Balaraj
- Departments of Surgery and Oncology, King Abdul-Aziz Medical City, Jeddah, Saudi Arabian National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Raouf Seyam
- Departments of Surgery and Oncology, King Abdul-Aziz Medical City, Jeddah, Saudi Arabian National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Mohammed Al Otaibi
- Departments of Surgery and Oncology, King Abdul-Aziz Medical City, Jeddah, Saudi Arabian National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Eyad Al Saeed
- Departments of Surgery and Oncology, King Abdul-Aziz Medical City, Jeddah, Saudi Arabian National Guard Health Affairs, Jeddah, Saudi Arabia
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McArthur C, McLaughlin G, Meddings RN. Changing the referral criteria for bone scan in newly diagnosed prostate cancer patients. Br J Radiol 2011; 85:390-4. [PMID: 21304009 DOI: 10.1259/bjr/79184355] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to correlate the prostate-specific antigen (PSA) level and Gleason score with staging bone scan result in patients with a new diagnosis of prostate cancer in order to establish the feasibility of implementing the European Association Urology guidelines, which state that a bone scan may not be indicated when PSA <20 in well-moderately differentiated tumours. METHODS We identified 633 patients retrospectively and 186 patients prospectively with a new diagnosis of prostate cancer undergoing a staging bone scan between March 2005 and January 2010. Patients were excluded if there was no Gleason score available or if the PSA level was checked over 3 months prior to bone scan. Bone scan results were analysed with respect to age, PSA level and Gleason score. In the case of an equivocal result, subsequent imaging was taken into consideration or the initial bone scan was re-reviewed. In persistently equivocal cases, all relevant imaging was assessed by a blinded panel of radiologists to allow a final decision to be made. RESULTS Of 672 patients aged 39-93 years (median 71 years), who fulfilled the inclusion criteria, 54 (8%) had evidence of bony metastases. PSA level and Gleason score were both independent predictors of bone scan positivity and their predictive value was additive p<0.01. None of the 357 patients with a PSA level of <20 and a Gleason score of <8 had a positive bone scan. CONCLUSION Staging bone scans in newly diagnosed prostate cancer patients with a PSA level of <20 and a Gleason score of <8 can be safely omitted, with these criteria having a negative predictive value of 100% in our series.
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Affiliation(s)
- C McArthur
- Department of Radiology, Ayr Hospital, Ayr, Ayr Hospital, Ayr, UK.
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Dimonte G. A cell kinetics model for prostate cancer and its application to clinical data and individual patients. J Theor Biol 2010; 264:420-42. [DOI: 10.1016/j.jtbi.2010.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 02/09/2010] [Accepted: 02/12/2010] [Indexed: 11/29/2022]
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When to Perform Bone Scan in Patients with Newly Diagnosed Prostate Cancer: External Validation of the Currently Available Guidelines and Proposal of a Novel Risk Stratification Tool. Eur Urol 2010; 57:551-8. [DOI: 10.1016/j.eururo.2009.12.023] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Accepted: 12/10/2009] [Indexed: 11/23/2022]
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The use of F-18 choline PET in the assessment of bone metastases in prostate cancer: correlation with morphological changes on CT. Mol Imaging Biol 2009; 11:446-54. [PMID: 19326171 DOI: 10.1007/s11307-009-0217-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM F-18 fluor choline-positron emission tomography/computed tomography (FCH-PET/CT) has emerged as a new diagnostic tool for the imaging of prostate cancer. In this study, we have evaluated the potential role of FCH-PET/CT for the assessment of bone metastases in patients with prostate cancer. Furthermore, we assessed the pattern of metabolic uptake by FCH in relation to morphologic changes on CT. METHODS Seventy men with biopsy-proven prostate cancer underwent FCH-PET/CT for preoperative staging or follow-up evaluation. Thirty-two patients were evaluated preoperatively, and 38 patients were referred for post operative evaluation of suspected recurrence or progression based on clinical algorithms. PET imaging consisted of a dynamic PET/CT acquisition of the pelvic region during 8 min (1-min frames) starting 1 min after i.v. injection of 4.07 MBq/kg/bw FCH which was followed immediately by a semi whole body acquisition. RESULTS Overall, 262 lesions showed increased uptake on FCH-PET. Two hundred ten lesions (210/262) were interpreted as bone metastases. The mean standardized uptake values (SUV) in all malignant lesions was 8.1 +/- 3.9. Forty-nine lesions (24%) had no detectable morphological changes on CT-probably due to bone marrow metastases. Fifty-six sclerotic lesions (having a Hounsfield unit (HU) level of more than 825) were interpreted as highly suspicious for metastatic bone disease on CT and/or other imaging modalities such as the bone scan but showed no FCH uptake. There was a significant correlation between tracer uptake as assessed by SUV and the density of sclerotic lesions by HU (r = -0.52, p < 0.001). The sensitivity, specificity, and accuracy of FCH-PET/CT in detecting bone metastases from prostate cancer was 79%, 97%, and 84%, respectively. CONCLUSION FCH-PET/CT showed promising results for the early detection of bone metastases in prostate cancer patients. We have found that a HU level of above 825 is associated with an absence of FCH uptake. Almost all of the FCH-negative sclerotic lesions were detected in patients who were under hormone therapy, which raises the possibility that these lesions might no longer be viable. However, clarification and the prognostic value of such lesions require further research.
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Lai MHY, Luk WH, Chan JCS. Predicting bone scan findings using sPSA in patients newly diagnosed of prostate cancer: feasibility in Asian population. Urol Oncol 2009; 29:275-9. [PMID: 19734069 DOI: 10.1016/j.urolonc.2009.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 05/11/2009] [Accepted: 05/11/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE A number of large-scaled studies done in Western countries have proven a positive relationship between serum prostate-specific antigen (PSA) level and prevalence of positive bone scan findings in newly diagnosed prostate cancer (CaP) patients. The objective of this study is to verify that the tendency occurs as well in Asian population, as well as to establish a possible correlation between PSA level, bone scan result, and Gleason score. METHOD Records of 116 patients diagnosed to have CaP were reviewed retrospectively for bone scan results, PSA levels, and Gleason score. RESULT Thirty-four patients were proven to have bone metastases based on positive bone scintigraphy result. None of these patients had a PSA level of less than 10 ng/ml. Two patients had PSA level between 11 and 20, and 15 patients had PSA level between 21 and 200. For patients with PSA level over 201, 17 had bone metastases on bone scintigraphy. CONCLUSION Based on the PSA level, the likelihood of positive bone scintigraphy result can be postulated. According to PSA levels, staging investigations can be more selective for patients with confirmed CaP. The risk of having positive bone scan is so low that it is not required for patients with PSA level less than 10 ng/ml. On the other hand, on studying the correlation between Gleason score and PSA level or bone scan results, no statistically significant relationship was established.
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Affiliation(s)
- Miranda H Y Lai
- Department of Diagnostic Radiology and Organ Imaging, United Christian Hospital, Hong Kong, China.
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Beheshti M, Vali R, Waldenberger P, Fitz F, Nader M, Hammer J, Loidl W, Pirich C, Fogelman I, Langsteger W. The use of F-18 choline PET in the assessment of bone metastases in prostate cancer: correlation with morphological changes on CT. Mol Imaging Biol 2009; 12:98-107. [PMID: 19588206 DOI: 10.1007/s11307-009-0239-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 06/27/2008] [Accepted: 09/08/2008] [Indexed: 12/22/2022]
Abstract
AIM F-18 fluor choline-positron emission tomography/computed tomography (FCH-PET/CT) has emerged as a new diagnostic tool for the imaging of prostate cancer. In this study, we have evaluated the potential role of FCH-PET/CT for the assessment of bone metastases in patients with prostate cancer. Furthermore, we assessed the pattern of metabolic uptake by FCH in relation to morphologic changes on CT. METHODS Seventy men with biopsy-proven prostate cancer underwent FCH-PET/CT for preoperative staging or follow-up evaluation. Thirty-two patients were evaluated preoperatively, and 38 patients were referred for postoperative evaluation of suspected recurrence or progression based on clinical algorithms. PET imaging consisted of a dynamic PET/CT acquisition of the pelvic region during 8 min (1 min frames) starting 1 min after i.v. injection of 4.07 MBq/kg/bw FCH, which was followed immediately by a semi-whole body acquisition. RESULTS Overall, 262 lesions showed increased uptake on FCH-PET. Two hundred ten lesions (210 of 262) were interpreted as bone metastases. The mean of maximum standardized uptake value (SUV(max)) in all malignant lesions was 8.1 +/- 3.9. Forty-nine lesions (24%) had no detectable morphological changes on CT-probably due to bone marrow metastases. Fifty-six sclerotic lesions (having a Hounsfield unit (HU) level of more than 825) were interpreted as highly suspicious for metastatic bone disease on CT and/or other imaging modalities such as the bone scan, but showed no FCH uptake. There was a significant correlation between tracer uptake as assessed by SUV and the density of sclerotic lesions by HU (r = -0.52, p < 0.001). The sensitivity, specificity, and accuracy of FCH-PET/CT in detecting bone metastases from prostate cancer was 79%, 97%, and 84%, respectively. CONCLUSION FCH-PET/CT showed promising results for the early detection of bone metastases in prostate cancer patients. We have found that a HU level of above 825 is associated with an absence of FCH uptake. Almost all of the FCH-negative sclerotic lesions were detected in patients who were under hormone therapy, which raises the possibility that these lesions might no longer be viable. However, clarification and the prognostic value of such lesions require further research.
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Affiliation(s)
- Mohsen Beheshti
- PET/CT Center Linz, St. Vincent's Hospital-Nuclear Medicine & Endocrinology, Linz, Austria.
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Pal RP, Thiruudaian T, Khan MA. When is a bone scan study appropriate in asymptomatic men diagnosed with prostate cancer? Asian J Androl 2008; 10:890-5. [DOI: 10.1111/j.1745-7262.2008.00427.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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