Retrospective Study of Predictors of Bone Metastasis in Prostate Cancer Cases

  • Ho, Christopher Chee Kong (Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre) ;
  • Seong, Poh Keat (Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre) ;
  • Zainuddin, Zulkifli Md (Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre) ;
  • Abdul Manaf, Mohd Rizal (Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre) ;
  • Parameswaran, Muhilan (Department of Surgery, Universiti Malaya) ;
  • Razack, Azad H.A. (Department of Surgery, Universiti Malaya)
  • Published : 2013.05.30


Introduction: The purpose of this study was to identify clinical profiles of patients with low risk of having bone metastases, for which bone scanning could be safely eliminated. Materials and Methods: This retrospective cross sectional study looked at prostate cancer patients seen in the Urology Departments in 2 tertiary centres over the 11 year period starting from January 2000 to May 2011. Patient demographic data, levels of PSA at diagnosis, Gleason score for the biopsy core, T-staging as well as the lymph node status were recorded and analysed. Results: 258 men were included. The mean age of those 90 men (34.9%) with bone metastasis was $69.2{\pm}7.3$ years. Logistic regression found that PSA level (P=0.000) at diagnosis and patient's nodal-stage (P=0.02) were the only two independent variables able to predict the probability of bone metastasis among the newly diagnosed prostate cancer patients. Among thowse with a low PSA level less than 20ng/ml, and less than 10ng/ml, bone metastasis were detected in 10.3% (12 out of 117) and 9.7% (7 out of 72), respectively. However, by combining PSA level of 10ng/ml or lower, and nodal negative as the two criteria to predict negative bone scan, a relatively high negative predictive value of 93.8% was obtained. The probability of bone metastasis in prostate cancer can be calculated with this formula: -1.069+0.007(PSA value, ng/ml)+1.021(Nodal status, 0 or 1)=x Probability of bone metastasis=$2.718^x/1+2.718^x$. Conclusion: Newly diagnosed prostate cancer patients with a PSA level of 10ng/ml or lower and negative nodes have a very low risk of bone metastasis (negative predictive value 93.8%) and therefore bone scans may not be necessary.


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