Do all patients with newly diagnosed prostate cancer need staging radionuclide bone scan? a retrospective study

purpose: define a group of patients with newly diagnosed prostate cancer, whose risk of bone metastasis is low enough to omit a bone scan staging study. materials and methods: from 2003 to 2009, the medical records of patients who were newly diagnosed with prostate cancer were retrospectively reviewed. the data collected included: age, digital rectal examination, serum prostate specific antigen (psa), gleason score, clinical t stage, and bone isotope scan. patients were divided into two groups according to the results of bone isotope scan; positive group and negative group. a univariate and multivariate binary logistic regression was used to analyze the results. results: of the 106 patients, 98 had a complete data collection and were entered into the study. the median age of the patients was 70.5 years and patients with a positive bone scan was 74 years, significantly higher than for patients with negative scans (69 years) (p = 0.02). bone metastasis was detected in 39 cases (39.7%). in all patients with clinical t1-2 stage, a gleason score of < 8 and psa = 20 ng/ml, the bone isotope scans were negative. in univariate analysis, psa (> 20 ng/ml) and gleason score (> 7) were independently predictive of positive bone scan, while clinical stage was not. conclusion: staging bone scans can be omitted in patients with a psa level of = 20 ng/ml, and gleason score < 8. our results suggest that by considering the gleason score and psa, a larger proportion of patients with prostate cancer could avoid a staging bone scan.