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Annals of Nuclear Medicine

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01-10-2012 | Original article

Higher scrotal uptake ratio of ^99mTc-MDP on bone scans in newly diagnosed prostate cancer: a reliable indicator of pelvic node metastasis

Authors: Maseeh uz Zaman, Nosheen Fatima, Zafar Sajjad, Ibrahim Hashmi, Khalil Khan

Published in: Annals of Nuclear Medicine | Issue 8/2012

Abstract

Objective

Pelvic lymph node dissection (PLND) is the gold standard procedure for nodal staging in prostate cancer (PC) but less commonly used due to its invasiveness. More commonly computerized tomography (CT) and magnetic resonance imaging (MRI) are used although these have limited sensitivities and specificities. The aim of this study was to find out the correlation between higher scrotal uptake ratio (SUR) of ^99mTc-methylene diphosphonate (MDP) on bone scan and pelvic node metastasis in patients with PC at high risk for nodal metastasis.

Methods

This was a retrospective study which included 68 biopsy proven newly diagnosed PC patients who had bone scan from January 2008 till January 2012. MRI of the pelvis, prostate specific antigen (PSA) and Gleason’s score were available in all patients. Whole body bone scan was performed in all patients and SUR was calculated by dividing mean counts over scrotum and soft tissue over lateral aspect of right thigh. PLND was carried out within 2–3 weeks of MRI study in these patients.

Results

Mean age of studied males was 71 ± 07 years with a mean PSA level of 65 ± 162 ng/ml. Prostate biopsy revealed adenocarcinoma in all patients with mean Gleason’s score 7 ± 1. Mean SUR was 2.786 ± 0.496. MRI was positive for pelvic lymphadenopathy in 32/68 (47 %). PLND revealed evidence of nodal metastasis in 16/68 (24 %) patients. Receiver operating characteristic analysis revealed good diagnostic strength of SUR for nodal metastasis with a cut off value of >2.99 with an area under curve (AUC) 0.708 (95 % CI 0.533–0.847, p value <0.05) and a mean sensitivity of 68.75 % and mean specificity of 80 %. Diagnostic strength of MRI for nodal metastasis was found to be low (AUC 0.566, 95 % CI 0.047–0.657, non-significant p value). No significant correlation was found between SUR and PSA in nodes positive and nodes negative patients.

Conclusion

We conclude that in newly diagnosed PC patients, higher SUR on bone scan has a high diagnostic accuracy for pelvic node metastasis. Furthermore, a bone scan with a SUR <2.99 and negative for bone metastasis can stratify newly diagnosed PC patients as low risk.

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Title: Higher scrotal uptake ratio of 99mTc-MDP on bone scans in newly diagnosed prostate cancer: a reliable indicator of pelvic node metastasis
Authors: Maseeh uz Zaman
Nosheen Fatima
Zafar Sajjad
Ibrahim Hashmi
Khalil Khan
Publication date: 01-10-2012
Publisher: Springer Japan
Published in: Annals of Nuclear Medicine / Issue 8/2012
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI: https://doi.org/10.1007/s12149-012-0626-z

At a glance: The STEP trials

Springer Medicine

Higher scrotal uptake ratio of ^99mTc-MDP on bone scans in newly diagnosed prostate cancer: a reliable indicator of pelvic node metastasis

Abstract

Objective

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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