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

Authors: Dotan, Z. A.; Bianco, F. J. Jr; Rabbani, F.; Eastham, J. A.; Fearn, P.; Scher, H. I.; Kelly, K. W.; Chen, H. N.; Schoder, H.; Hricak, H.; Scardino, P. T.; Kattan, M. W.
Article Title: Pattern of prostate-specific antigen (PSA) failure dictates the probability of a positive bone scan in patients with an increasing PSA after radical prostatectomy
Abstract: Purpose: Physicians often order periodic bone scans (BS) to check for metastases in patients with an increasing prostate-specific antigen (PSA; biochemical recurrence [BCR]) after radical prostatectomy (RP), but most scans are negative. We studied patient characteristics to build a predictive model for a positive scan. Patients and Methods: From our prostate cancer database we identified all patients with detectable PSA after RP. We analyzed the following features at the time of each bone scan for association with a positive BS: preoperative PSA, time to BCR, pathologic findings of the RP, PSA before the BS (trigger PSA), PSA kinetics (PSA doubling time, PSA slope, and PSA velocity), and time from BCR to BS. The results were incorporated into a predictive model. Results: There were 414 BS performed in 239 patients with BCR and no history of androgen deprivation therapy. Only 60 (14.5%) were positive for metastases. In univariate analysis, preoperative PSA (P = .04), seminal vesicle invasion (P = .02), PSA velocity (P < .001), and trigger PSA (P < .001) predicted a positive BS. In multivariate analysis, only PSA slope (odds ratio [OR], 2.71; P = .03), PSA velocity (OR, 0.93; P = .003), and trigger PSA (OR, 1.022; P < .001) predicted a positive BS. A nomogram for predicting the bone scan result was constructed with an overfit-corrected concordance index of 0.93. Conclusion: Trigger PSA, PSA velocity, and slope were associated with a positive BS. A highly discriminating nomogram can be used to select patients according to their risk for a positive scan. Omitting scans in low-risk patients could reduce substantially the number of scans ordered. © 2005 by American Society of Clinical Oncology.
Keywords: controlled study; major clinical study; postoperative period; preoperative evaluation; prostate specific antigen; demography; metastasis; prostate cancer; prostate-specific antigen; prostatic neoplasms; blood; kinetics; probability; prostatectomy; prostate tumor; bone; neoplasm metastasis; prediction and forecasting; predictive value of tests; scintiscanning; bone and bones; seminal vesicle; factual database; databases, factual; nomogram; androgen therapy; bone scintiscanning
Journal Title: Journal of Clinical Oncology
Volume: 23
Issue: 9
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2005-03-20
Start Page: 1962
End Page: 1968
Language: English
DOI: 10.1200/jco.2005.06.058
PUBMED: 15774789
PROVIDER: scopus
PMCID: PMC1850929
Notes: --- - "Cited By (since 1996): 67" - "Export Date: 24 October 2012" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. Zohar A Dotan
    19 Dotan
  2. Peter T Scardino
    621 Scardino
  3. Farhang Rabbani
    82 Rabbani
  4. Heiko Schoder
    285 Schoder
  5. Hedvig Hricak
    330 Hricak
  6. James Eastham
    426 Eastham
  7. Howard Scher
    816 Scher
  8. Fernando J Bianco
    72 Bianco
  9. Paul A Fearn
    58 Fearn
  10. Michael W Kattan
    218 Kattan
  11. Hui-Ni Chen
    17 Chen
  12. Katherine W Kelly
    7 Kelly