Prostate news article, October 2004
| IS A BONE SCAN
INDICATED IF THE PSA RISES AFTER RADICAL PROSTATECTOMY
Pablo Gomez, Marugesan Manoharan, Sandy S Kim and Mark S. Soloway British Journal of Urology, Int. 2004 : 94(3) ; 299-302. Reviewed by: Mr. J Bhardwa MBChB MRCS |
Up to one third of men undergoing radical prostatectomy eventually develop tumour recurrence and this may be either local (in the area where the prostate was) or distant, usually in the skeleton. This paper evaluates the role of a bone scan to detect a recurrence of prostate cancer and its spread to the bones after a radical retropubic prostatectomy (RRP). Of 1197 patients that had a RRP, 153 (12.8%) had a PSA greater than 0.4 ng/ml, which is the usual definition of a recurrence.
A bone scan is more suited than Computerised Tomography (CT) in detecting spread to the bones. Magnetic Resonance Imaging (MRI) cannot always distinguish between changes that are caused by treatment, fracture or tumour.
Several parameters such as symptoms of bone pain, hormonal treatment before operation, patient age and the level of the PSA at the time of the bone scan were taken into account. Of all the parameters the only one that had a significant impact on the whether or not the bone scan was positive was a PSA above 7 ng/ml.
The authors therefore suggest that a PSA value of more than 7 ng/ml or symptoms of bone pain should prompt the clinician to order a bone scan in men in whom tumour recurrence is suspected after radical prostatectomy. They also suggest that the PSA velocity (that is the rate at which the PSA rises) if greater than 0.5 ng/ml/month should alert the clinician to the possibility of secondary spread to the bones. This paper therefore reconfirms the usefulness of PSA monitoring after local treatment for prostate cancer.