Re-examining the role of whole body Bone Scan

Published Date: 19th July 2016

Publication Authors: Feyisetan O, McCabe JE

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Introduction

Current BAUS guidelines for staging prostate cancer include a radionuclide bone scan and MRI or CT of the pelvis/prostate. MRI has a higher sensitivity for detecting skeletal metastasis than bone scan. The aim of our study was to evaluate the incidence of metastasis to the appendicular skeleton in the absence of metastasis to the axial skeleton in prostate cancer. We then carried out a cost-benefit analysis and propose a newly emerging alternative staging method compared to the traditional bone scan.

Methods

Bone scans of all patients with a new diagnosis of prostate cancer at a large district general hospital between January 2012 and December 2013 were evaluated retrospectively.

Results

109 patients were identified (Mean age was 74.34?±?9.26 years; PSA range 2.1 to >1000). All were included. Of these, 74 (68%) had metastatic spread identified on bone scan. All 74 (100%) had axial skeleton involvement (pelvis and/or cervical/thoracic/lumbosacral spine). 52 (70%) of these in addition also had appendicular metastasis. Appendicular in the absence of axial skeleton metastasis was not seen. Minimum Gleason score in positive bone scans was 3 + 4.

Conclusion

We propose that performing a limited MRI spine (with DWI) at the time of pelvis/prostate MR will accurately stage patients without the need for a bone scan. In our institution, the additional time is estimated to be twenty minutes with little increase in cost per patient and significant savings from non-performance of bone scans. Moreover, the convenience to patients is one rather than two investigations.

Patel, C; Feyisetan, O; Slaven, K; McCabe, JE. (2014).  Re-examining the role of whole body Bone Scan in staging prostate cancer . BJU International. 113 (Suppl S5), 47

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