NEW YORK (Reuters Health) Mar 12 - Men with newly diagnosed prostate cancer whose prostate specific antigen (PSA) levels are low may not need a bone scan, according to a report in the February 15th issue of Cancer.
Dr. Shigeru Kosuda from National Defense Medical College in Tokorozawa, Japan and colleagues retrospectively assessed 1294 patients with newly diagnosed, untreated prostate carcinoma to determine whether serum PSA levels of 10 ng/mL or below might allow bone scans to be eliminated as part of the staging procedure.

Though the bone scans were positive in 287 patients (22.2%), the authors report, only 4 of 300 patients (1.33%) with serum PSA levels no higher than 10 ng/mL had bone metastasis from prostate cancer.

Elimination of the initial bone scan in these patients with low PSA levels in the hospitals that participated in the study would result in an estimated annual cost saving of $107.60 per year per patient with newly diagnosed prostate cancer, the report indicates.

"Because the 10-year disease specific survival rates for the PSA-alone strategy and the PSA-plus-bone-scan strategy were the same," the authors conclude, "our results suggest that baseline bone scans can be eliminated in patients with newly diagnosed prostate carcinoma who have PSA levels less than or equal to 10 ng/mL."

This is especially true in patients with tumors of Gleason Grade less than or equal to 2, or with a Gleason score of 6 or less, they write. However, Dr. Kosuda told Reuters Health, "Bone scan may be necessary for newly diagnosed prostate cancer patients with poorly differentiated adenocarcinoma or a high Gleason grade or score [and] patients with abnormal radiographs, such as osteoblastic changes, bone pain, and/or paralysis."

Dr. Kosuda also said that he would be more comfortable recommending against bone scans in newly diagnosed prostate cancer patients if a greater proportion of Japanese men underwent PSA screening earlier.

Cancer 2002;94:964-972.

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