Published 2021-07-15
Raden Danarto Indwiani Astuti Sofia Mubarika Haryana


Objective: We determine the utility of Prostate Specific Antigen (PSA) for predicting the presence of skeletal metastasis on Bone Scan (BS) in prostate cancer patients. Material & Methods: Retrospective analysis of medical records of 70 consecutive prostate cancer patients subjected to bone scan during the last 2 years was done. 5 cases were excluded due to the following reasons: Serum PSA not available, hormonal or other therapy given prior to serum PSA measurement, and/or Bone Scan, and symptomatic for bone metastasis. In remaining 65 cases, PSA value and bone scan were evaluated. Results: BS was found to be positive in 20/65 (31%) and negative in 45(69%) patients. 24 (37%) had serum PSA > 100 ng/ml, 25 (38.5%) had PSA of 20‐100 ng/ml and only 16 (24.5%) had PSA < 20 ng/ml. Conclusion: Serum PSA < 20 ng/ml have high predictive value in ruling out skeletal metastasis. Our data are in corroboration with results from previous studies that BS should be performed only if PSA > 20 ng/ml. Using this cut‐off, unnecessary investigation can be avoided. Avoiding BS asymptomatic in this group of patients would translate into a significant cost‐saving and reduction in their psychological and physical burden.



Bone scan, prostate Ca, prostate specific antigen


Miller DC, Hafez KS, Stewart A, Montie JE, Wei JT. Prostate carcinoma presentation, diagnosis, and staging: An update from the National Cancer Data Base. Cancer. 2003; 98: 1169–78.

Hsing AW, Chokkalingam AP. Prostate cancer epidemiology. Front Biosci. 2006; 11: 1388–413.

Schröder FH, Wildhagen MF Rotterdam Study Group of the ‘European Randomised Study of Screening for Prostate Cancer (ERSPC) Screening for prostate cancer: Evidence and perspectives. BJU Int. 2001; 88: 811–7.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009; 59: 225–49.

McGregor B, Tulloch AG, Quinlan MF, Lovegrove F. The role of bone scanning in the assessment of prostatic carcinoma. Br J Urol. 1978; 50: 178–81.

Varenhorst E, Alund G, Lindström E, Månson JC. Bone marrow aspiration biopsy and bone scanning in the staging of prostatic cancer. Br J Urol. 1983; 55: 534–7.

Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP, et al. EAU guidelines on prostate cancer. Eur Urol. 2008; 53: 68–80.

Goodman CM, Cumming JA, Ritchie AW, Chisholm GD. Prognostic value of raised prostatic acid phosphatase and negative skeletal scintigraphy in prostatic cancer. Br J Urol. 1991; 67: 622–5.

Haukaas S, Roervik J, Halvorsen OJ, Foelling M. When is bone scintigraphy necessary in the assessment of newly diagnosed, untreated prostate cancer? Br J Urol. 1997; 79: 770–6.

Chybowski FM, Keller JJ, Bergstralh EJ, Oesterling JE. Predicting radionuclide bone scan findings in patients with newly diagnosed, untreated prostate cancer: Prostate specific antigen is superior to all other clinical parameters. J Urol. 1991; 145: 313–8.

O'Sullivan JM, Norman AR, Cook GJ, Fisher C, Dearnaley DP. Broadening the criteria for avoiding staging bone scans in prostate cancer: A retrospective study of patients at the Royal Marsden Hospital. BJU Int. 2003; 92: 685–9.

Shih WJ, Wierzbinski B, Collins J, Magoun S, Chen IW, Ryo UY. Serum osteocalcin measurements in prostate carcinoma patients with skeletal deposits shown by bone scintigram: Comparison with serum PSA/PAP measurements. J Nucl Med. 1990; 31: 1486–9.

Kosuda S, Yoshimura I, Aizawa T, Koizumi K, Akakura K, Kuyama J, et al. Can initial prostate specific antigen determinations eliminate the need for bone scans in patients with newly diagnosed prostate carcinoma? A multicenter retrospective study in Japan. Cancer. 2002; 94: 964–72.

Oesterling JE, Martin SK, Bergstralh EJ, Lowe FC. The use of prostate-specific antigen in staging patients with newly diagnosed prostate cancer. JAMA. 1993; 269: 57–60.

Gleave ME, Coupland D, Drachenberg D, Cohen L, Kwong S, Goldenberg SL, et al. Ability of serum prostate-specific antigen levels to predict normal bone scans in patients with newly diagnosed prostate cancer. Urology. 1996; 47: 708–12.

Rudoni M, Antonini G, Favro M, Baroli A, Brambilla M, Cardani G, et al. The clinical value of prostate-specific antigen and bone scintigraphy in the staging of patients with newly diagnosed, pathologically proven prostate cancer. Eur J Nucl Med. 1995; 22: 207–11.

Ataus S, Citçi A, Alici B, Onder AU, Sönmezoğlu K, Erözenci A, et al. The value of serum prostate specific antigen and other parameters in detecting bone metastases in prostate cancer. Int Urol Nephrol. 1999; 31: 481–9.

Rydh A, Tomic R, Tavelin B, Hietala SO, Damber JE. Predictive value of prostate-specific antigen, tumour stage, and tumour grade for the outcome of bone scintigraphy in patients with newly diagnosed prostate cancer. Scand J Urol Nephrol. 1999; 33: 89–93.

Bruwer G, Heyns CF, Allen FJ. Influence of local tumour stage and grade on reliability of serum prostate-specific antigen in predicting skeletal metastases in patients with adenocarcinoma of the prostate. Eur Urol. 1999; 35: 223–7.

Lee N, Fawaaz R, Olsson CA, Benson MC, Petrylak DP, Schiff PB, et al. Which patients with newly diagnosed prostate cancer need a radionuclide bone scan? An analysis based on 631 patients. Int J Radiat Oncol Biol Phys. 2000; 48: 1443–6.

Kemp PM, Maguire GA, Bird NJ. Which patients with prostatic carcinoma require a staging bone scan? Br J Urol. 1997; 79: 611–4.

Ishizuka O, Tanabe T, Nakayama T, Kawakami M, Kinebuchi Y, Nishizawa O. Prostate-specific antigen, Gleason sum and clinical T stage for predicting the need for radionuclide bone scan for prostate cancer patients in Japan. Int J Urol. 2005; 12: 728–32.

Wolff JM, Zimny M, Borchers H, Wildberger J, Buell U, Jakse G. Is prostate-specific antigen a reliable marker of bone metastasis in patients with newly diagnosed cancer of the prostate? Eur Urol. 1998; 33: 376–81.

Copyright Information
Department of Urology, Faculty of Medicine/Airlangga University