World J Urol (2012) 30:265–269 DOI 10.1007/s00345-011-0728-6 O R I G I N A L A R T I C L E Is it suitable to eliminate bone scan for prostate cancer patients with PSA · 20 ng/mL? Seung Hwan Lee · Mun Su Chung · Kyung Kgi Park · Chan Dong Yom · Dae Hoon Lee · Byung Ha Chung Received: 18 April 2011 / Accepted: 30 June 2011 / Published online: 16 July 2011 © The Author(s) 2011. This article is published with open access at Springerlink.com Abstract Purpose We evaluated the relationship between bone metastasis (BM) and clinical or pathological variables, including the serum prostate-speciWc antigen (PSA) con- centration. Methods This retrospective study included 579 consecu- tive patients with newly diagnosed prostate cancer (Pca) who underwent a bone scan study at our institution between 2002 and 2010. We used receiver operating characteristics curves to evaluate accuracy of bone metastasis between serum PSA 10 and 20 ng/mL. Results A positive bone scan result was found in 83 men (14.3%) with PCa. However, 27 men (4.6%) with serum PSA between 10 and 20 ng/mL, 29/579 men (5.0%) with GS · 7, and 21/83 (25.3%) with serum PSA · 20 ng/mL and Gleason score (GS) · 7 had positive bone scans. In the logistic regression analyses, clinical T stage (odds ratio [OR] = 3.26; 95% CI, 2.29–4.33; P = 0.021), GS (OR = 3.41; 95% CI, 2.91–4.63; P = 0.019), and serum PSA (OR = 8.37; 95% CI, 3.91–19.21; P < 0.001) were predictive factors of detecting the BM. When the serum PSA concentration ·20 ng/mL and GS · 7, AUC value of bone scans for the detection of BM was 0.640 (P = 0.020; 95% CI, 0.563–0.717). With serum PSA at 10 ng/mL and GS · 7, the AUC values of bone scans were 0.828 (P < 0.001; 95% CI, 0.773–0.883). Conclusions Bone scans might be necessary in men with serum PSA between 10 and 20 ng/mL. New guidelines for S. H. Lee · M. S. Chung · K. K. Park · C. D. Yom · D. H. Lee · B. H. Chung (&) Department of Urology, Yonsei University Health System, Gangnam Severance Hospital, Yongdong, P.O. Box 1217, Seoul, Korea e-mail: chung646@yuhs.ac eliminating bone scans in patients with newly diagnosed Pca are needed, especially in Asians. Keywords Bone scan · Prostate cancer · Prostate · Bone metastasis · PSA Introduction Considering that the most frequent site of metastatic pros- tate carcinoma is bone [1], detection of bone metastasis is important when deciding the treatment strategy of prostate cancer. Bone scanning is the most sensitive modality for the detection of bone metastasis but it is also an expensive and time-consuming staging modality [2]. Therefore, it is important to seek a balance between cost and beneWt. According to the American Urologic Association (AUA) and European Association of Urology (EAU) guidelines, scanning may not be necessary for those with serum pros- tate-speciWc antigen (PSA) · 20 ng/mL when they have Gleason score (GS) · 7 [3, 4]. These guidelines are reX- ected in the clinical guidelines for prostate cancer published by the Japanese Urological Association in 2006 [5]. However, it has not been suYciently investigated whether this standard is suitable for Asians with relatively small prostates in size or lower serum PSA levels [6, 7]. In Japan, a multicenter retrospective study suggests the inci- dence of positive bone scanning in patients with low PSA levels is much higher than that in other studies conducted in North America and Europe [8]. According to mass popula- tion screening in Korea, the distribution of serum PSA val- ues in Koreans was diVerent from that obtained in Caucasians [9]. Therefore, we evaluated the relationship between bone metastasis and clinical or pathological variables, including 123