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Bone scan findings in a North African ethnic group and relation to PSA levels and Gleason score of the biopsy
Resultados de gammagrafías óseas en individuos de etnia norteafricana y su relación con los niveles de APE y con la escala de Gleason obtenida en biopsia
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Facultad de Medicina de la Universidad Mohammed V de Rabat" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resultados de gammagrafías óseas en individuos de etnia norteafricana y su relación con los niveles de APE y con la escala de Gleason obtenida en biopsia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">According to the American Cancer Society, prostate cancer (CaP) is the most common type of cancer found in American men, apart from skin cancer. The estimated number of new cases of CaP in the United States in 2009 was about 192<span class="elsevierStyleHsp" style=""></span>280, and the assessed deaths will be 26<span class="elsevierStyleHsp" style=""></span>730. It is known that there is a wide geographic variation in the incidence of clinical prostate cancer. In the African population, the incidence and mortality rates of CaP are strikingly higher than those in Chinese or Caucasian ethnic groups.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> There is evidence that genetic, environmental and social factors jointly, often in combination, contribute to the observed differences in various populations. However due to the increasing awareness of the disease entity, the advent of the prostate specific antigen (PSA) testing for screening or early diagnosis and the improvement in life expectancy of the male population, the epidemiology of CaP in the North-African ethnic group has changed.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In our city, the incidence of new cases of PCa is rapidly increasing, from 358 new cases registered in 1997 to 1068 cases in 2007, nearly tripling in 10 years. According to our national cancer register, a crude incidence rate is rising and the disease is being found earlier as well. However, the mortality from CaP is relatively static, with the number of deaths at 121 in 1997 and 289 in 2007, respectively. This implies that an increasing number of our citizens are living with prostate cancer.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Considering that the skeleton is the most painful and debilitating site of metastasis of CaP, skeletal screening is crucial in management planning and assessing the prognosis in the early disease stage. Skeletal scintigraphy is the investigation of choice in diagnosing bone metastases; it is more sensitive than skeletal radiography and serum alkaline phosphatase levels, it is good in its accessibility, non-invasiveness, low radiation dose, and above all, its ability to evaluate the entire skeletal system.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Our purpose is to determine whether the probability of positive bone scan result of newly diagnosed CaP patients can be predicted by serum PSA level in the North-African population, with an attempt to define a particular PSA level under which the group of patients would have low risk of obtaining a positive bone scan, so that the radiologic procedure can be safely omitted.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Moreover, we would like to correlate the Gleason score with PSA level and probability of positive bone scintigraphy results. It is to determine whether there is any relation between the histologic grade, tumour marker level, and the aggressiveness of the tumour itself in our ethnic group.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patients and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">At the university military hospital, all the patients aged 45–85 with prostatic symptoms (i.e., obstructive or irritative urinary symptoms and hematuria) would have a baseline serum PSA level taken, together with transrectal ultrasound (TRUS) guided prostate biopsy and bone scintigraphy; according to the European Association of Urology guidelines.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A retrospective computer search of our urologic department records of the period between January 1997 and December 2007 was performed, reviewing all the patients who had undergone TRUS prostate biopsy and had pathologically proven CaP. A total of 348 consecutive patients were included. They all had TRUS prostate biopsies, serum PSA levels, and bone scans within 4 weeks of one another. Patients who had had previous therapy for prostatic diseases, including androgen ablation therapy, radiation therapy on prostate or prostate surgery were excluded from the study.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Statistical analyses were performed using Fisher's exact test, by statistical software (SPSS, Statistical Package for the Social Sciences, version 11.5.1, Chicago, IL) with differences at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 considered significant.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The serum PSA level was analysed with the VITROS Immunodiagnostic Products PSA Calibrators (Ortho-Clinical Diagnostics, Inc., Rochester, NY) with the corresponding VITROS Immunodiagnostic Products PSA Reagent Pack.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Bone scintigrams were performed with technetium-99m HDP. The dose of Tc-99m HDP used was approximately 20<span class="elsevierStyleHsp" style=""></span>mCi (740<span class="elsevierStyleHsp" style=""></span>MBq) and scanning was performed by a single head gamma camera (prism 1000; Picker International Inc., Highland Heights, OH). A high-resolution collimator was used and whole body anterior and posterior planner images, together with oblique and localised views for areas of interest were reviewed. The bone scintigrams were reviewed by 2 radiologists with 13 and 7-year experience in radiology (WHL) (MHYL), respectively.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Sextant prostate tissue biopsies were performed by urologists under ultrasound guidance (C9-5 transrectal US curved array probe, ATL. HDI 5000 system; Philips, Irvine, CA); 20-gauge Temno biopsy puncture needles (Santo Domingo, Dominican Republic, Cardinal Health) were employed. The tissues cropped were sent to the anatomic and cellular pathology department of our university hospital for tissue diagnosis.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">The patients were 46–85 with a mean age of 68 years. PSA levels ranged from 2 to 998<span class="elsevierStyleHsp" style=""></span>ng/ml with a mean value of 86.63<span class="elsevierStyleHsp" style=""></span>ng/ml. The time interval between PSA determination and bone scan was within 27 days.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Bone metastases were identified in 102 out of 348 patients. The patients were stratified into 4 groups according to their PSA level: the first group of patients had a PSA level ranging from 0 to 10<span class="elsevierStyleHsp" style=""></span>ng/ml (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>75), the second group had a PSA level ranging from 11 to 20<span class="elsevierStyleHsp" style=""></span>ng/ml (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>63), the third group had a PSA ranging from 21 to 100<span class="elsevierStyleHsp" style=""></span>ng/ml (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>159), and the fourth group was those having a serum PSA level higher than 100<span class="elsevierStyleHsp" style=""></span>ng/ml (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>51). The prevalence of osseous metastases proven by bone scintigrams increased progressively with PSA level, rising from 0% (0 out of 75) for PSA level <11<span class="elsevierStyleHsp" style=""></span>ng/ml, to 100% (51 out of 51) for PSA level >100<span class="elsevierStyleHsp" style=""></span>ng/ml (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). Bone scintigraphy results with respect to PSA levels are summarised in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The Gleason score ranged from 2 to 10, with the overall mean Gleason score being 6.336. In 3 patients, no Gleason score was given by the pathologist and only the presence of adenomatous carcinoma was stated. These three slides were already destroyed at the time of this study according to storage protocol.</p><p id="par0070" class="elsevierStylePara elsevierViewall">When we compared the mean Gleason score in the four groups of patients with different PSA levels, this was only slightly higher in the group with a PSA higher than100<span class="elsevierStyleHsp" style=""></span>ng/ml. No statistically significant relation was established between the PSA level and the Gleason score (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05).</p><p id="par0075" class="elsevierStylePara elsevierViewall">In comparing the Gleason scores to bone scan findings, we found that the mean Gleason scores were 6.808 and 7.249 for the groups with negative and positive bone scan results, respectively. There was no statistically significant relation between the 2 groups (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Prostate cancer shows tremendous difference in its incidence in different populations worldwide. Asian men typically have a very low incidence and mortality of CaP in contrast to northern European, African and American populations.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> There is a doubt whether the behaviour of CaP in the African population is different from that in western countries. Due to the mortality rate of CaP in the African population, many CaP patients may live with the disease for a considerable period of time.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Screening out patients with advanced disease or bone metastases is essential in order to prevent complications from bone destruction, and to improve the quality of life of these patients.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The diagnosis of bone metastasis secondary to prostate cancer significantly alters the patient's treatment. Currently, radionuclide bone scans are the gold standard for detecting osseous metastasis. An ongoing debate surrounds the optimal PSA for recommending a bone scan for non-metastatic prostate carcinomas. Detecting bone metastases is essential in predicting prognosis, and identifying or preventing complications incurred by disease progression. However, if for every patient newly diagnosed with CaP bone scintigraphy was offered as the baseline staging investigation, the increase in incidence would imply a growing burden on the healthcare system. It is, therefore, important to seek a balance between cost and benefit, and to develop an algorithm for the indication of a baseline bone scintigraphy.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">According to a number of large-scaled studies in the USA and Canada,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> a progressive rising relation in the prevalence of skeletal metastases with PSA level has been proved. Several papers advocated that bone scan is not indicated when pre-treatment PSA levels are low, and when patients are rather D’Amico low risk.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> However, different studies established different cut-off levels for indication of bone scintigraphy.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In newly diagnosed cases, the incidence of positive bone scans in patients with PSA lower than 20<span class="elsevierStyleHsp" style=""></span>ng/ml is low. According to Chybowski: in a group of 521 American subjects with untreated newly diagnosed prostate cancer, bone scan finding showed that bone metastasis did not occur in patients with PSA levels of 15<span class="elsevierStyleHsp" style=""></span>ng/ml or lower, but it did occur in 1 patient (0.3%) with a PSA level of 15–20<span class="elsevierStyleHsp" style=""></span>ng/ml.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Rhoden et al. studied a group of 214 patients with 35 positive bone scans: only 1 of those was in the group with a PSA lower than 20<span class="elsevierStyleHsp" style=""></span>ng/ml. Such studies led to a recommendation to avoid staging bone scans in patients with PSA lower than 20<span class="elsevierStyleHsp" style=""></span>ng/ml.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Despite many recent numerous studies and reviews citing 10<span class="elsevierStyleHsp" style=""></span>ng/ml as a threshold PSA for omitting bone scans, others still believe that the small but measurable risk is sufficient to warrant continued scanning.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,10</span></a> Therefore, there is a reluctance to make an absolute recommendation, and bone scan continues to be used by many physicians and urologists in the staging process of the disease.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Oesterling examined the relations among bone metastases, PSA, pathohistologic differentiation, and local findings in 852 subjects with untreated prostate cancer. The likelihood of bone metastases in men with PSA levels <10<span class="elsevierStyleHsp" style=""></span>ng/ml was 0.5% (4/852). In those with levels <20<span class="elsevierStyleHsp" style=""></span>ng/ml, the incidence of bone metastases was only 0.8% (7/852), and of these 7 men, 5 had bone pain. Of the 4 patients in their study with PSA levels of 10<span class="elsevierStyleHsp" style=""></span>ng/ml or lower, only 1 patient had bone metastasis without bone pain.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">According to a multi-centre retrospective study in Japan, the incidence of positive bone scan in the patient group with low PSA levels in their mass population screening is much higher than that in the other studies performed in Western countries. This raises the suspicion that the behaviour of CaP is different in the Asian population compared with Caucasians, and the PSA might not be a good indicator for predicting bone scintigraphy results in some ethnic groups.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">In another study performed by Gleave et al., a group from Canada, only 6% out of 490 patients with newly diagnosed CaP had positive bone scan on initial evaluation. Scans were positive in none of the 290 patients with PSA levels below 10<span class="elsevierStyleHsp" style=""></span>ng/ml, 4 out of 88 (4.5%) with PSA levels between 10 and 20<span class="elsevierStyleHsp" style=""></span>ng/ml, and 24 out of 122 (21%) with PSA levels between 21 and 100<span class="elsevierStyleHsp" style=""></span>ng/ml.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">However, in contrast to the other studies carried out in western countries, a multi-centre retrospective study in Japan has revealed that bone metastasis is common in Japanese patients with newly diagnosed, untreated prostate carcinoma, with an overall positive rate of 24.2% on bone scans.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The positive rate is approximately double that reported in the United States and Canada (8.9%).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Besides, according to Ito et al., of the 303 patients identified to have CaP in a mass screening program in 9671 subjects, 36 had bone metastasis. 13 (36%) of the 36 patients had PSA levels of 10<span class="elsevierStyleHsp" style=""></span>ng/ml or less.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The incidence of having positive bone scan in a patient group with low PSA levels is much higher than in the other studies in western countries. It is therefore certain that the behaviour and histopathologic characters of CaP are different according to the continent, the geographic origin, the race and the ethnic group.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">In our study, the prevalence of bone metastases in newly diagnosed CaP patients is 102 out of 348 (29.3%), with a rate much higher than that in the reports carried out by researchers in western countries. It could be partly explained by our sample selection. There is no population-based screening program for CaP in our nation. Our hospital adopted symptomatic screening instead, in order to ensure early diagnosis. All cases in our series presented with lower urinary tract symptoms and subsequent digital rectal examination, PSA, and TRUS were done to screen for CaP. This might have contributed to the higher incidence of advanced disease, that is, having bone metastases, in those newly diagnosed CaP patients.</p><p id="par0130" class="elsevierStylePara elsevierViewall">A positive relation between the PSA level and presence of bone metastasis on bone scan was demonstrated in our study, having a trend in line with the other studies.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,14</span></a> With PSA 10<span class="elsevierStyleHsp" style=""></span>ng/ml or less, none of the patients had a positive bone scan. If we take a serum PSA value of 10<span class="elsevierStyleHsp" style=""></span>ng/ml or lower as a threshold, the negative predictive value of a positive bone scan result would be 100% (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01), that is, no false negative case. Radionuclide bone scans may therefore be omitted as a routine baseline staging tool in patients with such a negligible risk for positive bone scan results.</p><p id="par0135" class="elsevierStylePara elsevierViewall">In our study sample, if bone scans were omitted for patients having a level of PSA of 10<span class="elsevierStyleHsp" style=""></span>ng/ml or lower, 75 out of 348 men (21.6%) of the routine staging bone scans would be avoided.</p><p id="par0140" class="elsevierStylePara elsevierViewall">On the other hand, if imaging had been denied only to those men with a PSA level of 20<span class="elsevierStyleHsp" style=""></span>ng/ml or less, imaging sensitivity would have decreased to 94%, but 63 more men could have been omitted from bone scan, that is, 138 out of 348 (39.7%) routine staging bone scans would be avoided.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Currently, performing bone scintigraphy is time-consuming, taking several hours to complete; and it costs about US$ 100 per examination. Time and resources for radionuclide bone scans could be saved for other purposes if the request could be more selective. This was a significant source of savings in the present climate of economic constraints and managed health care.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Our recommendation is to delay the radionuclide bone scans in this group of patients having PSA<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>ng/ml until the PSA level rises or when symptoms (e.g. bone pain) arise.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Conversely, for PSA levels higher than 100<span class="elsevierStyleHsp" style=""></span>ng/ml, all the subjects in our study had proven to have skeletal metastases on radionuclide bone scan. The positive predictive value using a cut-off point of a serum PSA higher than 100<span class="elsevierStyleHsp" style=""></span>ng/ml is 100% (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). This implies that arranging an early appointment for bone scintigraphy is necessary, for planning local treatment (e.g. radiotherapy) in order to prevent complications such as pathological fracture and spinal cord compromise. The radionuclide bone scan could also act as a baseline to indicate treatment response and, later, presence of recurrent metastatic disease.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> In our hospital, clinical urologists would actually plan for orchiectomy and chemotherapy for this group of patients without waiting for the bone scan results.</p><p id="par0160" class="elsevierStylePara elsevierViewall">In studying the correlation of the Gleason score with bone scan findings and PSA levels, no statistically significant relationship was established. No clinical value bas been added to this study.</p><p id="par0165" class="elsevierStylePara elsevierViewall">The major limitation of this study is that it is retrospective, and the patients were not recruited from a population-based screening program. The vast majority of the men in our series presented with lower urinary tract symptoms. The patient sample is different from that of the other studies with which we have made a comparison. On the other hand, the presence or absence of metastases is not tissue biopsy proven, and bone scan is actually not the true gold standard.</p><p id="par0170" class="elsevierStylePara elsevierViewall">According to the last report of the European Association of Urology (EAU), in Barcelona (April 2010): skeletal scintigraphy with doubtful lesions must be explored by functional MR imaging of the axial skeleton, to attach fixation abnormalities to their inflammatory, traumatic, or neoplastic etiology. In some cases remaining in diagnosis litigation (e.g. unique bone lesion in an unusual area of prostatic metastases), a biopsy is recommended to carry a certain histologic diagnosis.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">In most European and American centres, axial skeleton MRI is a fast exam, which can be coupled to lymph node staging evaluation during the same sequences (T1–T2). Both its sensibility and specificity are better than scintigraphic accuracy in all bone types and areas except for the skull's arch and ribs.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16</span></a> However, this technique is not widely standardised; this limitation can explain varied sensibility (42–100%) and specificity (82–94%). The usefulness of a detection whole body MRI “Scinti-MRI” is still being tested in the perspective of a large validation.</p><p id="par0180" class="elsevierStylePara elsevierViewall">To reach a compromise between adapting our practise to the EAU guidelines<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and our university hospital's economic conjuncture, skeletal scintigraphy remains the investigation of choice in diagnosing bone metastases; it is appropriate because of its accessibility, non-invasiveness, low-radiation dose, and above all, its ability to evaluate the entire skeletal system.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,15</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Bone scanning has also been an important tool in monitoring disease progression after definitive therapy. However, the same controversy exists about the optimal post-treatment PSA at which to recommend this test.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,14</span></a> To date, only small series that correlate the prevalence of bone metastases with PSA after local therapy have been published.</p><p id="par0190" class="elsevierStylePara elsevierViewall">In the face of increasing health care costs, clinicians are constantly expected to reassess the diagnostic tools and the treatment of patients with regard to economic considerations as well as best practise.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0195" class="elsevierStylePara elsevierViewall">Progressive rising incidence of bone metastasis on radionuclide bone scan in relation to the PSA levels in patients newly diagnosed with CaP is proven. Very high negative predictive value (100%) could be achieved by using a PSA level of 10<span class="elsevierStyleHsp" style=""></span>ng/ml as a cut-off point for indication of bone scan in our ethnic group. The positive predictive value using a cut-off point of a serum PSA higher than 100<span class="elsevierStyleHsp" style=""></span>ng/ml is 100%.</p><p id="par0200" class="elsevierStylePara elsevierViewall">Using PSA as an indicator for the presence of bony metastases rather than routine bone scans would have large economic savings given the population size. However, our recommendations are restricted only to symptomatic screening and cannot be extrapolated to population-based screening programs due to the sample selection of the study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres99956" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Material and methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec87121" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres99957" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Material y método" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec87122" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-03-06" "fechaAceptado" => "2011-03-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec87121" "palabras" => array:5 [ 0 => "Prostate specific antigen (PSA)" 1 => "Prostate cancer" 2 => "Bone metastases" 3 => "Bone scintigraphy" 4 => "Gleason score" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec87122" "palabras" => array:5 [ 0 => "Antígeno prostático específico (APE)" 1 => "Cáncer prostático" 2 => "Metástasis óseas" 3 => "Gammagrafía ósea" 4 => "Escala de Gleason" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A number of large-scaled studies carried out in western countries have proven a positive relationship between serum prostate specific antigen (PSA) level and prevalence of positive bone scan findings, in newly diagnosed prostate cancer patients. The aim of our study is to verify that the tendency occurs as well in North-African population, as well as to establish a possible correlation between PSA level, bone scan result, and Gleason score.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Records of 348 patients diagnosed to have prostatic adenocarcinoma were reviewed retrospectively for bone scan results, PSA levels, and Gleason score. Statistical analyses were performed using the Fisher's exact test, by a statistical software (statistical package for the social sciences “SPSS”, version 11.5.1, Chicago, IL) with differences at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 considered significant.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Based on positive bone scintigraphy 102 patients were proven to have bone metastases. None of these patients had a PSA level of lower than 10<span class="elsevierStyleHsp" style=""></span>ng/ml. Six metastatic patients had PSA level between 11 and 20<span class="elsevierStyleHsp" style=""></span>ng/ml. 45 metastatic cases had serum PSA between 21 and 100. Concerning PSA level over 101<span class="elsevierStyleHsp" style=""></span>ng/ml, 51 men had positive bone scan.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Based on the PSA level, the likelihood of positive bone scan result can be postulated. According to PSA levels, staging investigations can be more selective for our patients. The risk of positive bone scan is so low that it is not required for patients with PSA level lower than 10<span class="elsevierStyleHsp" style=""></span>ng/ml. On the other hand, on studying the correlation between Gleason score and PSA level or bone scan results, no statistically significant relationship was established.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Numerosos estudios a gran escala realizados en países occidentales han demostrado una relación positiva entre el nivel sérico de antígeno prostático específico (APE) y la prevalencia de hallazgos positivos en la gammagrafía ósea en pacientes recientemente diagnosticados de cáncer de próstata. El objetivo de nuestro estudio es comprobar si esta tendencia aparece también en población norteafricana, así como determinar si se produce una relación entre los niveles de APE, los resultados de la gammagrafía ósea y la escala de Gleason.</p> <span class="elsevierStyleSectionTitle">Material y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se revisaron de manera retrospectiva las historias clínicas de 348 pacientes diagnosticados de adenocarcinoma prostático, extrayendo los resultados de las gammagrafías óseas, los niveles de APE y la escala de Gleason. Se llevó a cabo un análisis estadístico mediante la prueba exacta de Fisher, utilizando el programa estadístico SPSS (Paquete Estadístico para las Ciencias Sociales, versión 11.5.1, Chicago), considerando significativa una <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Mediante la gammagrafía ósea se demostró la existencia de metástasis óseas en 102 pacientes. Ninguno de estos pacientes tenía un nivel de APE menor de 10<span class="elsevierStyleHsp" style=""></span>ng/ml. Seis pacientes con metástasis tenían un nivel de APE entre 11 y 20<span class="elsevierStyleHsp" style=""></span>ng/ml. En 45 casos con metástasis se hallaron niveles de APE sérico entre 21 y 100. En relación con los niveles de APE superiores a 101<span class="elsevierStyleHsp" style=""></span>ng/ml, 51 hombres presentaban gammagrafía ósea positiva.</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Tomando como referencia los niveles de APE, se podría presuponer la probabilidad de un resultado positivo en la gammagrafía ósea. Según los niveles de APE, las investigaciones de estadificación pueden ser más selectivas en el caso de nuestros pacientes. En pacientes con un nivel de APE inferior a 10<span class="elsevierStyleHsp" style=""></span>ng/ml, el riesgo de presentar una gammagrafía ósea positiva es tan bajo que no sería necesario realizarla. Por otro lado, no se ha establecido una relación con significado estadístico entre la escala de Gleason y el nivel de APE o los resultados de la gammagrafía ósea.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article: Janane A, et al. Resultados de gammagrafías óseas en individuos de etnia norteafricana y su relación con los niveles de APE y con la escala de Gleason obtenida en biopsia. Actas Urol Esp. 2011;35:534–9.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">PSA 1evel (ng/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Bone scan positive for metastases (102) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Bone scan negative for metastases (246) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Mean Gleason score<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11–20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21–100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">114 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183858.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara"><span class="elsevierStyleItalic">P</span> value<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "<p class="elsevierStyleNotepara"><span class="elsevierStyleItalic">P</span> value<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Radionuclide bone scan results and Gleason scores based on PSA levels.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Scintigraphy result \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">PSA mean (range) (ng/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Gleason score mean (range)<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive for metastases (102) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">157.09 (17–998) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.249 (6–10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative for metastases (246) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.30 (2–91) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.808 (4–10) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab183857.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara"><span class="elsevierStyleItalic">P</span> value<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Comparison of PSA values and Gleason scores with results of skeletal scintigraphy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cambios en la densidad mineral ósea. comparación entre pacientes con cáncer de próstata con o sin metástasis y varones sanos (grupo étnico norteafricano)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 2 | 0 | 2 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 8 | 0 | 8 |
| 2018 January | 5 | 0 | 5 |
| 2017 December | 2 | 1 | 3 |
| 2017 November | 8 | 0 | 8 |
| 2017 October | 19 | 2 | 21 |
| 2017 September | 11 | 1 | 12 |
| 2017 August | 6 | 0 | 6 |
| 2017 July | 10 | 3 | 13 |
| 2017 June | 16 | 10 | 26 |
| 2017 May | 9 | 2 | 11 |
| 2017 April | 16 | 2 | 18 |
| 2017 March | 21 | 6 | 27 |
| 2017 February | 19 | 1 | 20 |
| 2017 January | 10 | 0 | 10 |
| 2016 December | 12 | 3 | 15 |
| 2016 November | 13 | 1 | 14 |
| 2016 October | 25 | 10 | 35 |
| 2016 September | 16 | 1 | 17 |
| 2016 August | 19 | 1 | 20 |
| 2016 July | 11 | 2 | 13 |
| 2016 June | 10 | 6 | 16 |
| 2016 May | 18 | 10 | 28 |
| 2016 April | 16 | 5 | 21 |
| 2016 March | 21 | 8 | 29 |
| 2016 February | 26 | 12 | 38 |
| 2016 January | 19 | 13 | 32 |
| 2015 December | 16 | 4 | 20 |
| 2015 November | 13 | 3 | 16 |
| 2015 October | 16 | 8 | 24 |
| 2015 September | 10 | 3 | 13 |
| 2015 August | 15 | 3 | 18 |
| 2015 July | 10 | 2 | 12 |
| 2015 June | 2 | 3 | 5 |
| 2015 May | 15 | 2 | 17 |
| 2015 April | 26 | 7 | 33 |
| 2015 March | 22 | 5 | 27 |
| 2015 February | 14 | 2 | 16 |
| 2015 January | 33 | 5 | 38 |
| 2014 December | 43 | 9 | 52 |
| 2014 November | 15 | 2 | 17 |
| 2014 October | 44 | 8 | 52 |
| 2014 September | 35 | 7 | 42 |
| 2014 August | 56 | 4 | 60 |
| 2014 July | 36 | 5 | 41 |
| 2014 June | 24 | 3 | 27 |
| 2014 May | 23 | 5 | 28 |
| 2014 April | 20 | 3 | 23 |
| 2014 March | 30 | 0 | 30 |
| 2014 February | 20 | 5 | 25 |
| 2014 January | 10 | 1 | 11 |
| 2013 December | 19 | 4 | 23 |
| 2013 November | 26 | 4 | 30 |
| 2013 October | 18 | 1 | 19 |
| 2013 September | 4 | 2 | 6 |
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