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PSA and bone scans


Some time ago Bandolier (issues 2 and 26 ) drew attention to the use of serum PSA concentrations to avoid necessity of bone scans in men with prostate cancer. If the PSA was below a certain level (10 to 20 µg/L) then men did not have bone secondaries, so an unpleasant and costly diagnostic procedure could be avoided by using a simple test.

But that intervention was US in origin, so it is comforting to find a UK study which comes up with the same finding [1].

Study

This was a study of all patients referred for a bone scan over 18 months. They had to have prostate cancer, bone scan and PSA with 4 weeks of each other, bone scan findings were unequivocal or confirmed by other imaging methods and no treatment was started before tests were done.

Results

Information on 98 men was available. No man with a serum PSA of 20 µg/L or below had a positive bone scan. The results were essentially identical to previous (if larger) US studies.

Comment

The selective omission of a bone scan in men with prostate cancer and a PSA of less than 20 µg/L at diagnosis could save over £1 million a year in the UK. Not a massive saving, but every little helps, and it does stop unnecessary interventions involving radiation exposure.

Reference:

  1. PM Kemp, GA Maguire, NJ Bird. Which patients with prostatic carcinoma require a staging bone scan? British Journal of Urology 1997 79: 611-4.



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