Bone scintigraphy in staging of newly diagnosed prostate cancer in regard of different risk groups

Document Type : Short communication


1 1Department of Urology, SMZ Ost, Donauspital, Vienna

2 Department of Urology, University of Vienna

3 Department of Nuclear Medicine with PET-Center, Wilhelminenspital, Vienna

4 Department of Urology, Wilhelminenspital, Vienna

5 Department of Pathology, Wilhelminenspital, Vienna

6 Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Vienna


Objective(s): Prostate cancer (PC) is the most common cancer in men over 50 years of age. Bone scintigraphy is still performed in many institutions at the time of primary diagnosis. We aimed to evaluate the role of bone scan in the primary staging of PC in regard of different risk groups.
Methods: A retrospective analysis of bone scans in 296 patients (mean age 64±6 y) acquired at the time of primary diagnosis was performed in our institution. The median prostate specific antigen (PSA) was 6.73 ng/ml, all patients had a Gleason score of >5.
Results: Only 11/296 patients had a positive bone scan, 1 being in the intermediate risk group, 10 in the high-risk group and none in the low-risk group according to D’Amico classification.
Conclusion: Our results support the few published studies that less than 10% of patients with newly diagnosed PC by biopsy would develop bone metastasis, all in the intermediate or high-risk groups. Therefore, a staging by bone scan can only be recommended in patients with intermediate or high-risk, or symptomatic patients only.


Main Subjects

  1. Groot MT, Boeken Kruger CG, Pelger RC, Uyl-de Groot CA. Costs of prostate cancer, metastatic to the bone, in the Netherlands. Eur Urol. 2003;43(3):226-32.
  2. Tombal B, Lecouvet F. Modern detection of prostate cancer’s bone metastasis: is the bone scan era over? Adv Urol. 2012;2012:893193.
  3. Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006;12(20 Pt 2):6243S-9S.
  4. Zacho HD, Barsi T, Mortensen JC, Mogensen MK, Bertelsen H, Josephsen N, et al. Prospective multicenter study of bone scintigraphy in consecutive patients with newly diagnosed prostate cancer. J Clin Nucl Med. 2014;39(1):26-31.
  5. Ishizuka O, Tanabe T, Nakayama T, Kawakami M, Kinebuchi Y, Nishizawa O. Prostate-specific antigen, gleason sum and clinical T stage for predicting the need for radionuclide bone scan for prostate cancer patients in Japan. Int J Urol. 2005;12(8):728-32.
  6. Ho CC, 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(5):3289-92.
  7. D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998;280(11):969-74.
  8. Chybowski FM, Keller JJ, Bergstralh EJ, Oesterling JE. Predicting radionuclide bone scan findings in patients with newly diagnosed, untreated prostate cancer: prostate specific antigen is superior to all other clinical parameters. J Urol. 1991;145(2):313-8.
  9. Soloway MS, Hardeman SW, Hickey D, Raymond J, Todd B, Soloway S, et al. Stratification of patients with metastatic prostate cancer based on extent of disease on initial bone scan. Cancer. 1988;61(1):195-202.
  10. Langsteger W, Haim S, Knauer M, Waldenberger P, Emmanuel K, Loidl W, et al. Imaging of bone metastases in prostate cancer: an update. Q J Nucl Med Mol Imaging. 2012;56(5):447-58.
  11. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol. 2014;65(2):467-79.
  12. Wymenga LF, Boomsma JH, Groenier K, Piers DA, Mensink HJ. Routine bone scans in patients with prostate cancer related to serum prostate-specific antigen and alkaline phosphatase. BJU Int. 2001;88(3):226-30.
  13. Szot W, Kostkiewicz M, Zając J, Owoc A, Bojar I. Prostate cancer in patients from rural and suburban areas--PSA value, Gleason score and presence of metastases in bone scan. Ann Agric Environ Med. 2014;21(4):888-92.
  14. Luboldt W, Küfer R, Blumstein N, Toussaint TL, Kluge A, Seemann MD, et al. Prostate carcinoma: diffusion-weighted imaging as potential alternative to conventional MR and 11C-choline PET/CT for detection of bone metastases. Radiology. 2008;249(3):1017-25.
  15. Kitajima K, Murphy RC, Nathan MA. Choline PET/ CT for imaging prostate cancer: an update. Ann Nucl Med. 2013;27(7):581-91.
  16. Mease RC, Foss CA, Pomper MG. PET imaging in prostate cancer: focus onprostate-specific membrane antigen. Curr Top Med Chem. 2013;13(8):951-62.
  17. Lütje S, Heskamp S, Cornelissen AS, Poeppel TD, van den Broek SA, Rosenbaum-Krumme S, et al. PSMA ligands for radionuclide imaging and therapy of prostate cancer: clinical status. Theranostics. 2015;5(12):1388-401.
  18. Beheshti M, Langsteger W, Fogelman I. Prostate cancer: role of SPECT and PET in imaging bone metastases. Semin Nucl Med. 2009;39(6):396-407.
  19. Donohoe KJ, Cohen EJ, Giammarile F, Grady E, Greenspan BS, Henkin RE, et al. Appropriate use criteria for bone scintigraphy in prostate and breast cancer: summary and excerpts. J Nucl Med. 2017;58(4):14N-7N.
  20. Lee SH, Chung MS, Park KK, Yom CD, Lee DH, Chung BH. Is it suitable to eliminate bone scan for prostate cancer patients with PSA ≤ 20 ng/mL? World J Urol. 2012;30(2):265-9.