Bone scan in staging prostate cancer- pro

Staging of any cancer requires an assessment of distant metasases. At the same time, for most cancer types, groups that have too low of a chance of having metastatic diseae can be defined, and generally these groups can be spared the cost and discomfort of imaging to look for them.

The American Urological Association (AUA) and the European Association of Urology (EAU)  and NCCN provide guideliens that have a bearing on this question in prostate cancer. The AUA guideline provides no specific indications concerning imaging for patients undergoing radical prostatectomy. However, the PSA best practice statement of the AUA guidelines reports that routine imaging staging and bone scans are not necessary in every case of diagnosed prostate cancer. In particular, imaging is thought unnecessary if the PSA is <25 ng/mL and bone scans are not recommended when PSA is <20 ng/mL.

The EAU guidelines on prostate cancer were first published in 2001 and recently  ( and frequently) updated. The latest version in 2011 says that a bone scan to rule out skeletal metastases may not be appropriate in asymptomatic patients if the serum PSA level is less than 20 ng/mL in the presence of well or moderately differentiated tumors. TThe NCCN on p. PROS-1 defiens the appropriate group for bone scanning to be T1 and PSA >20,T2 and PSA >10,Gleason score 8,T3, T4, symptomatic disease.

Guidelines for the management of clinically localized prostate cancer: 2007 update,”

“Prostate-specific antigen best practice statement: 2009 update,”

A Heidenreich, M Bolla, S Joniau, et al., “EAU guidelines on prostate cancer,” European Association of Urology, 2011.

nccn, Prostate 2013

A. Simonato et al, Adherence to Guidelines among Italian Urologists on Imaging Preoperative Staging of Low-Risk Prostate Cancer: Results from the MIRROR (Multicenter Italian Report on Radical Prostatectomy Outcomes and Research) Study, Advances in Urology
Volume 2012 (2012), Article ID 651061, 6 pages

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