Are serial bone scans useful for the follow-up of clinically localized, low to intermediate grade prostate cancer managed with watchful observation alone?
| Autor: | Gerard Morton, Richard Choo, Cyril Danjoux, L. Klotz, Gerrit DeBoer, B.K. Yap |
|---|---|
| Rok vydání: | 2003 |
| Předmět: | |
| Zdroj: | BJU International. 91:613-617 |
| ISSN: | 1464-410X 1464-4096 |
| DOI: | 10.1046/j.1464-410x.2003.04169.x |
| Popis: | OBJECTIVE To assess the predictive value of serial bone scans as a surveillance tool for bone metastasis in men with clinically localized prostate cancer and managed with watchful observation. PATIENTS AND METHODS A prospective single-arm study was conducted to assess the feasibility of a watchful observation protocol with selective delayed intervention for patients with clinically localized prostate cancer, i.e. T1b-T2bN0M0, a Gleason score of ≤ 7 and a prostate-specific antigen (PSA) level of ≤ 15 ng/mL. Patients were managed expectantly as long as they did not meet the empirically predefined criteria of clinical, histological or PSA progression. Bone scintigraphy was repeated every year for the first 2 years, then every 2 years thereafter if the patient remained on watchful observation. When the follow-up PSA level was> 15 ng/mL the patient underwent bone scintigraphy every year. RESULTS In all, 244 eligible patients were enrolled into the study. With a median follow-up of 30 months, 449 bone scans were taken (150 at baseline and 299 in follow-up evaluations); all 299 follow-up scans were negative for bone metastasis. Hence, the true rate of positive follow-up bone scans was estimated to be 0–1.0% (95% confidence). In all, 171 patients had at least one follow-up bone scan; of these, the number (%) of patients who had 1, 2, 3, 4 and ≥ 5 follow-up scans was 89 (52), 53 (31), 17 (10), eight (4.7) and four (2.3), respectively. The PSA levels (ng/mL) corresponding to all follow-up bone scans were: 214 scans at PSA < 10, 61 at 10–14.9, 18 at 15–19.9 and six at ≥ 20 (range 20.2–24.9). The probability of a negative bone scan was estimated to be 88–100% (95% confidence interval) when a PSA threshold of 15 ng/mL was used. CONCLUSION The probability of positive findings in serial bone scans in untreated, localized, low to intermediate grade prostate cancer was low when the follow-up PSA level remained 15 ng/mL, the role of serial bone scintigraphy remains undefined, as a longer follow-up and a larger sample are needed. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|