Limited role of radionuclide bone scintigraphy in patients with prostate specific antigen elevations after radical prostatectomy
Limited role of radionuclide bone scintigraphy in patients with prostate specific antigen elevations after radical prostatectomy
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DOI：
10.1016/s0022-5347(01)62545-x
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发表时间：
1998-10-01
影响因子：
6.6
通讯作者：
Wood, DP
中科院分区：
文献类型：
--
作者：
Cher, ML;Bianco, FJ;Wood, DP
目的：前列腺癌根治术后血清前列腺特异性抗原(PSA)升高的患者骨显像仅有极少数阳性。我们确定的临床参数将提高我们选择患者进行这项成像研究的能力。材料和方法：我们回顾了1991年至1996年在我们机构进行的所有骨显像检查，这些患者在前列腺癌根治术后血清PSA持续升高。促使临床医生获得骨显像的是触发式PSA(TPSA)。用前列腺癌根治术后的tPSA/时间(斜率I)和上次检测不到的PSA的tPSA/时间(斜率2)来衡量PSA/tPSA的增高率。结果：在单因素分析中，tPSA(p=0.003)、斜率1(p=0.005)和斜率2(p=0.004)对骨显像结果有预测作用，而病理分期、Gleason评分、术前PSA和复发时间不能预测骨显像结果。在多变量分析中，预测骨显像结果最有用的参数是tPSA(p=0.01)。根据Logistic回归模型，在tPSA升高到40~45 ng/ml之前，骨显像阳性的概率小于5%。结论：在前列腺癌根治术后血清PSA升高的患者中，当前血清PSA是预测骨显像结果的最佳指标。此外，在PSA增加到30到40纳克/毫升之前，骨显像的用处是有限的。
Purpose: Bone scintigrams of patients with increasing serum prostate specific antigen (PSA) after radical prostatectomy are only rarely positive. We identify clinical parameters that would improve our ability to select patients for this imaging study.Materials and Methods: We reviewed all bone scintigrams done at our institution between 1991 and 1996 in patients with persistently increasing serum PSA after radical prostatectomy. What prompted the clinician to obtain the bone scintigram was trigger PSA (tPSA). The rate of increase in PSA to tPSA was measured by tPSA/time from radical prostatectomy (slope I) and tPSA/time from last undetectable PSA (slope 2). These parameters were evaluated together with standard clinicopathological data in univariate and multivariate analyses to determine the ability to predict the bone scintigram result.Results: In univariate analysis tPSA (p = 0.003), slope 1 (p = 0.005) and slope 2 (p = 0.004) were useful in predicting the bone scintigram result but pathological stage, Gleason score, preoperative PSA and time to recurrence were not. In multivariate analysis the single most useful parameter in predicting the bone scintigram result was tPSA (p = 0.01). Based on a logistic regression model the probability of a positive bone scintigram was less than 5% until tPSA increased to 40 to 45 ng./ml.Conclusions: In patients with increasing serum PSA after radical prostatectomy current serum PSA is the best predictor of the bone scintigram result. Furthermore, there is limited usefulness of bone scintigraphy until PSA increases above 30 to 40 ng./ml.