Asia Oceania Journal of Nuclear Medicine and Biology

Asia Oceania Journal of Nuclear Medicine and Biology

Whole-Body Bone Scan for Detecting Bone Metastasis in the Prostate-Specific Membrane Antigen Positron Emission Tomography Era: A Retrospective Cohort Study of Post-Radical Prostatectomy Prostate Cancer Patients

Document Type : Original Article

Authors
Chanikarn Poenateetai 1
Achiraya Teyateeti 2
Pawana Pusuwan 1
Ajalaya Teyateeti 1
1 Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
2 Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
10.22038/aojnmb.2025.82544.1582
Abstract
Objective(s): To determine the detection rate of bone metastasis on bone scan of prostate cancer patients with rising serum prostate-specific antigen (PSA) following radical prostatectomy (RP) and to identify the predictive factors associated with bone metastasis.
Methods: A study was conducted in 120 patients with rising serum PSA after RP. The data collected were pre and post-RP clinical parameters, including a trigger PSA (tPSA) level that prompted the treating physician to request a bone scan and PSA doubling time (PSADT). Bone scans were classified as positive or negative in conjunction with follow-up imaging and clinical information.
Results: Of 120 bone scans, 6 (5%) were positive and 114 (95%) were negative for bone metastasis. In the median tPSA ranges of <0.5, 0.5-1.0, and >1.0 ng/mL, scan positivity was 2.1%, 6.3%, and 30%, respectively. Patients with positive scans showed higher tPSA (1.228 vs 0.256 ng/mL; p=0.003) and shorter PSADT (3.5 vs 12.2 months; p=0.005) than those with negative scans. The most significant predictors of a positive bone scan were tPSA (>1 vs ≤1 ng/mL; OR 15.286, 95% CI 2.594-90.064, p=0.003) and PSADT (<6 vs ≥6 months; OR 17.333, 95% CI 1.618-185.646, p=0.018).
Conclusion: The detection rate of bone metastasis on bone scans in post-RP recurrent prostate cancer patients is only 5%, but the probability is much higher with tPSA >1 ng/mL and PSADT <6 months. Given its wide accessibility in Thailand, a bone scan should remain the preferred screening test for bone metastasis, with expected positive results in patients with high or rapidly rising PSA levels.
Keywords
prostate cancer
radical prostatectomy
biochemical recurrence
bone metastasis
bone scan
Subjects
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Asia Oceania Journal of Nuclear Medicine and Biology
Volume 13, Issue 2
July 2025
Pages 146-155