860 DOES BEING ON ADT ALTER THE ABILITY OF PSA AND PSADT TO PREDICT A POSITIVE BONE SCAN? RESULTS FROM THE SEARCH DATABASE (2010)

You have accessJournal of UrologyProstate Cancer: Advanced III1 Apr 2010860 DOES BEING ON ADT ALTER THE ABILITY OF PSA AND PSADT TO PREDICT A POSITIVE BONE SCAN? RESULTS FROM THE SEARCH DATABASE Daniel Moreira, William Aronson, Martha Terris, Joseph Presti, Christopher Amling, Christopher Kane, and Stephen Freedland Daniel MoreiraDaniel Moreira Durham, NC More articles by this author , William AronsonWilliam Aronson Los Angeles, CA More articles by this author , Martha TerrisMartha Terris Augusta, GA More articles by this author , Joseph PrestiJoseph Presti Palo Alto, CA More articles by this author , Christopher AmlingChristopher Amling Portland, OR More articles by this author , Christopher KaneChristopher Kane San Diego, CA More articles by this author , and Stephen FreedlandStephen Freedland Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1616AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients after biochemical recurrence following radical prostatectomy are at risk for developing bone metastasis. Bone scans are routinely used to detect metastasis, however most scans are negative. PSA levels and PSA kinetics (PSAV, PSADT) have been correlated with risk of positive bone scan in hormone-naive men. Whether they also predict bone scan positivity among men receiving ADT is not known. Therefore, we determined the predictors of a positive bone scan after biochemical recurrence following radical prostatectomy in both hormone-naive and men on ADT from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. METHODS Retrospective analysis of 268 bone scans of 189 men not receiving ADT and 177 scans of 114 patients on ADT after biochemical recurrence following radical prostatectomy in the SEARCH cohort. The association of patients' demographics, pathological features, PSA levels and PSA kinetics with risk of a positive bone scan was done with generalized estimating equations. RESULTS Among hormone-naive subjects, 13 (5%) scans were positive and 255 (95%) were negative for metastasis. Positive bone scan was associated with shorter time from PSA recurrence to scan (P=0.047), higher pre-scan PSA (P<0.001), shorter PSADT (P<0.001) and higher PSA velocity (P<0.001). In patients receiving ADT, 29 (16%) scans were positive and 184 (84%) were negative. Positive scan was associated with seminal vesicle invasion (P=0.035), higher pre-scan PSA (P<0.001), shorter PSADT (P=0.005) and higher PSA velocity (P<0.001). For men not on ADT, all scans (n=130) with a PSADT >9 months were negative, regardless of the PSA level. For men on ADT with a PSADT >9 months, 5% of scans were positive (3/59), some even at low PSA values (<5 ng/ml). As PSA rose to >10 ng/ml, the risk of a positive scan increased and was ∼50% for men with a PSADT <9 months regardless of ADT status (5/9 not on ADT and 15/30 for men on ADT). Adjusted for PSA level, PSADT and PSAV, scans obtained after ADT were more likely to be positive (OR=5.00, P=0.004). CONCLUSIONS Higher PSA velocity, shorter PSADT and higher PSA levels before bone scan were all associated with greater risk of positive bone scan regardless of ADT status. However, for a given PSA level and PSA kinetic parameter (PSADT and PSAV), men on ADT were much more likely to have a positive scan. Thus, the combination of absolute PSA levels, PSA kinetics with ADT status may be used to reduce the number of unnecessary scans. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e335-e336 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Moreira Durham, NC More articles by this author William Aronson Los Angeles, CA More articles by this author Martha Terris Augusta, GA More articles by this author Joseph Presti Palo Alto, CA More articles by this author Christopher Amling Portland, OR More articles by this author Christopher Kane San Diego, CA More articles by this author Stephen Freedland Durham, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...