Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical Research

Predicting bone scan positivity in non-metastatic castration-resistant prostate cancer

Prostate Cancer and Prostatic Diseases volume 18, pages 333–337 (2015)Cite this article

Subjects

Abstract

Background:

To evaluate PSA levels and kinetic cutoffs to predict positive bone scans for men with non-metastatic castration-resistant prostate cancer (CRPC) from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort.

Methods:

Retrospective analysis of 531 bone scans of 312 clinically CRPC patients with no known metastases at baseline treated with a variety of primary treatment types in the SEARCH database. The association of patients’ demographics, pathological features, PSA levels and kinetics with risk of a positive scan was tested using generalized estimating equations.

Results:

A total of 149 (28%) scans were positive. Positive scans were associated with younger age (odds ratio (OR)=0.98; P=0.014), higher Gleason scores (relative to Gleason 2–6, Gleason 3+4: OR=2.03, P=0.035; Gleason 4+3 and 8–10: OR=1.76, P=0.059), higher prescan PSA (OR=2.11; P<0.001), shorter prescan PSA doubling time (PSADT; OR=0.53; P<0.001), higher PSA velocity (OR=1.74; P<0.001) and more remote scan year (OR=0.92; P=0.004). Scan positivity was 6, 14, 29 and 57% for men with PSA<5, 5–14.9, 15–49.9 and ⩾50 ng ml−1, respectively (P-trend <0.001). Men with PSADT ⩾15, 9–14.9, 3–8.9 and <3 months had a scan positivity of 11, 22, 34 and 47%, correspondingly (P-trend <0.001). Tables were constructed using PSA and PSADT to predict the likelihood of a positive bone scan.

Conclusions:

PSA levels and kinetics were associated with positive bone scans. We developed tables to predict the risk of positive bone scans by PSA and PSADT. Combining PSA levels and kinetics may help select patients with CRPC for bone scans.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Derleth CL, Yu EY . Targeted therapy in the treatment of castration-resistant prostate cancer. Oncology 2013; 27: 620–628.

    PubMed  Google Scholar 

  2. Schellhammer PF, Chodak G, Whitmore JB, Sims R, Frohlich MW, Kantoff PW . Lower baseline prostate-specific antigen is associated with a greater overall survival benefit from sipuleucel-T in the immunotherapy for prostate adenocarcinoma treatment (IMPACT) trial. Urology 2013; 81: 1297–1302.

    Article  PubMed  Google Scholar 

  3. Nelius T, Reiher F, Lindenmeir T, Klatte T, Rau O, Burandt J et al. Characterization of prognostic factors and efficacy in a phase-II study with docetaxel and estramustine for advanced hormone refractory prostate cancer. Onkologie 2005; 28: 573–578.

    CAS  PubMed  Google Scholar 

  4. Kantoff PW, Higano CS, Shore ND, Berger ER, Small EJ, Penson DF et al. Sipuleucel-T immunotherapy for castration-resistant prostate cancer. N Engl J Med 2010; 363: 411–422.

    Article  CAS  PubMed  Google Scholar 

  5. Basch E, Autio K, Ryan CJ, Mulders P, Shore N, Kheoh T et al. Abiraterone acetate plus prednisone versus prednisone alone in chemotherapy-naive men with metastatic castration-resistant prostate cancer: patient-reported outcome results of a randomised phase 3 trial. Lancet Oncol 2013; 14: 1193–1199.

    Article  CAS  PubMed  Google Scholar 

  6. Beer TM, Armstrong AJ, Rathkopf DE, Loriot Y, Sternberg CN, Higano CS et al. Enzalutamide in metastatic prostate cancer before chemotherapy. N Engl J Med 2014; 371: 424–433.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Slovin SF, Wilton AS, Heller G, Scher HI . Time to detectable metastatic disease in patients with rising prostate-specific antigen values following surgery or radiation therapy. Clin CancerRes 2005; 11: 8669–8673.

    Article  CAS  Google Scholar 

  8. Okotie OT, Aronson WJ, Wieder JA, Liao Y, Dorey F, De KJ et al. Predictors of metastatic disease in men with biochemical failure following radical prostatectomy. J Urol 2004; 171: 2260–2264.

    Article  PubMed  Google Scholar 

  9. Dotan ZA, Bianco FJ Jr., Rabbani F, Eastham JA, Fearn P, Scher HI et al. Pattern of prostate-specific antigen (PSA) failure dictates the probability of a positive bone scan in patients with an increasing PSA after radical prostatectomy. J Clin Oncol 2005; 23: 1962–1968.

    Article  PubMed  Google Scholar 

  10. Loeb S, Makarov DV, Schaeffer EM, Humphreys EB, Walsh PC . Prostate specific antigen at the initial diagnosis of metastasis to bone in patients after radical prostatectomy. J Urol 2010; 184: 157–161.

    Article  PubMed  Google Scholar 

  11. Moreira DM, Cooperberg MR, Howard LE, Aronson WJ, Kane CJ, Terris MK et al. Predicting bone scan positivity after biochemical recurrence following radical prostatectomy in both hormone-naive men and patients receiving androgen-deprivation therapy: results from the SEARCH database. Prostate Cancer Prostatic Dis 2014; 17: 91–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Allott EH, Abern MR, Gerber L, Keto CJ, Aronson WJ, Terris MK et al. Metformin does not affect risk of biochemical recurrence following radical prostatectomy: results from the SEARCH database. Prostate Cancer Prostatic Dis 2013; 16: 391–397.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Scher HI, Halabi S, Tannock I, Morris M, Sternberg CN, Carducci MA et al. Design and end points of clinical trials for patients with progressive prostate cancer and castrate levels of testosterone: recommendations of the Prostate Cancer Clinical Trials Working Group. J Clin Oncol 2008; 26: 1148–1159.

    Article  PubMed  Google Scholar 

  14. Hamilton RJ, Aronson WJ, Terris MK, Kane CJ, Presti JC Jr., Amling CL et al. Limitations of prostate specific antigen doubling time following biochemical recurrence after radical prostatectomy: results from the SEARCH database. J Urol 2008; 179: 1785–1789; discussion 1789-1790.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wright JL, Salinas CA, Lin DW, Kolb S, Koopmeiners J, Feng Z et al. Prostate cancer specific mortality and Gleason 7 disease differences in prostate cancer outcomes between cases with Gleason 4+3 and Gleason 3+4 tumors in a population based cohort. J Urol 2009; 182: 2702–2707.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Freedland SJ, Humphreys EB, Mangold LA, Eisenberger M, Dorey FJ, Walsh PC et al. Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA 2005; 294: 433–439.

    Article  CAS  PubMed  Google Scholar 

  17. Cookson MS, Roth BJ, Dahm P, Engstrom C, Freedland SJ, Hussain M et al. Castration-resistant prostate cancer: AUA Guideline. J Urol 2013; 190: 429–438.

    Article  PubMed  Google Scholar 

  18. Smith MR, Kabbinavar F, Saad F, Hussain A, Gittelman MC, Bilhartz DL et al. Natural history of rising serum prostate-specific antigen in men with castrate nonmetastatic prostate cancer. J Clin Oncol 2005; 23: 2918–2925.

    Article  PubMed  Google Scholar 

  19. Smith MR, Cook R, Lee KA, Nelson JB . Disease and host characteristics as predictors of time to first bone metastasis and death in men with progressive castration-resistant nonmetastatic prostate cancer. Cancer 2011; 117: 2077–2085.

    Article  PubMed  Google Scholar 

  20. Smith MR, Saad F, Oudard S, Shore N, Fizazi K, Sieber P et al. Denosumab and bone metastasis-free survival in men with nonmetastatic castration-resistant prostate cancer: exploratory analyses by baseline prostate-specific antigen doubling time. J Clin Oncol 2013; 31: 3800–3806.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Davis NB, Ryan CW, Stadler WM, Vogelzang NJ . A phase II study of nilutamide in men with prostate cancer after the failure of flutamide or bicalutamide therapy. BJU Int 2005; 96: 787–790.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was funded by the Department of Veterans Affairs, National Institutes of Health grant R01CA100938 (WJA), NIH Specialized Programs of Research Excellence grant P50 CA92131-01A1 (WJA), the Georgia Cancer Coalition (MKT), NIH K24 CA160653 (SJF) and Amgen.

Disclaimer

Views and opinions of, and endorsements by, the author(s) do not reflect those of the US Army or the Department of Defense.

Author information

Authors and Affiliations

  1. Department of Urology, Mayo Clinic, Rochester, MN, USA

    D M Moreira

  2. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA

    L E Howard

  3. Urology Section, Veterans Affairs Medical Center, Durham, Durham, NC, USA

    L E Howard, K N Sourbeer, H S Amarasekara, L C Chow, D C Cockrell, B T Hanyok, C L Pratson & S J Freedland

  4. Division of Urology, Department of Surgery, and the Duke Prostate Center, Duke University School of Medicine, Durham, NC, USA

    L E Howard, K N Sourbeer, H S Amarasekara, L C Chow, D C Cockrell, B T Hanyok, C L Pratson & S J Freedland

  5. Department of Surgery, Urology Section, Veterans Affairs Medical Center, Greater Los Angeles, Los Angeles, CA, USA

    W J Aronson

  6. Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA, USA

    W J Aronson

  7. Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, CA, USA

    C J Kane

  8. Division of Surgery, Veterans Affairs Medical Centers and Division of Urologic Surgery, Department of Surgery, Urology Section, Medical College of Georgia, Augusta, GA, USA

    M K Terris

  9. Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA, USA

    M K Terris

  10. Division of Urology, Department of Surgery, Oregon Health & Science University, Portland, OR, USA

    C L Amling

  11. Department of Urology, University of California, San Francisco, San Francisco, CA, USA

    M R Cooperberg

  12. Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    M R Cooperberg

  13. Department of Surgery, Urology Section, Veterans Affairs Medical Center, San Francisco, CA, USA

    M R Cooperberg

  14. Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA

    A Liede

  15. Department of Pathology, Duke University School of Medicine, Durham, NC, USA

    S J Freedland

Authors
  1. D M Moreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L E Howard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K N Sourbeer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H S Amarasekara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L C Chow
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D C Cockrell
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B T Hanyok
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C L Pratson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. W J Aronson
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. C J Kane
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M K Terris
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. C L Amling
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. M R Cooperberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. A Liede
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. S J Freedland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D M Moreira.

Ethics declarations

Competing interests

AL is employed by Amgen. The remaining authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on the Prostate Cancer and Prostatic Diseases website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moreira, D., Howard, L., Sourbeer, K. et al. Predicting bone scan positivity in non-metastatic castration-resistant prostate cancer. Prostate Cancer Prostatic Dis 18, 333–337 (2015). https://doi.org/10.1038/pcan.2015.25

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/pcan.2015.25

This article is cited by

Search

Advanced search

Quick links