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PROSTATE-SPECIFIC ANTIGEN (PSA) AS A MARKER OF PROGRESSION ON BONE SCINTIGRQPHY IN HORMONALLY TREATED PATIENTS WITH ADVANCED PROSTATE CANCER
Article published in Urologia Polska 1999/52/2.

authors

Arkadiusz Piłatowicz 1, Izabella Kozłowicz-Gudzińska 2, Wojciech Michalski 3
Centrum Onkologii-lnstytutu im. Marii Skłodowskiej-Curie w Warszawie
Dyrektor: mgr B. Mucha
1 Klinika Nowotworów Układu Moczowego
Kierownik: dr n. med. P. Siedlecki
2 Zakład Medycyny Nuklearnej
Kierownik: doc. dr hab. I. Kozłowicz-Gudzińska
3 Pracownia Biostatystyki
Kierownik: mgr E. Kraszewska

keywords

prostate cancer hormonal therapy PSA bone scintigraphy

summary

Background. In Poland approximately 90% of prostate cancer patients have
advanced disease at presentation. In such patients the disease is beyond the
scope of radical treatment and hormonotherapy represents basic treatment
modality. Currently the standard of monitoring the progression in such patients
calls for serum PSA determinations every 3-6 months and bone scintigrqphy
every 12 months. Monitoring of such patients with PSA determinations alone
rises large interest, as PSA assays are many times less expensive than bono
scintigrqphy.
Objective. The study was aimed to determine the treshold value of PSA
level below which the probability of progression on bone scintigrqphy in
hormonally treated prostate cancer patients low. The study was also aimed to
determine the treshold value of PSA level above which the probability of
progression on bone scintigrqphy in hormonally treated prostate cancer patients
is close to 100%.
Material and method. The retrospective analysis was performed on 240
hormonally treated advanced prostate cancer patients (stage C and D according
to Whitmore-Jewett classification). Negative and positive predictive value of
PSA assay for progression on bone scintigrqphy were analysed.
Results. It was found that the negative predictive value of PSA reaches the
highest value for PSA less than 1 ng/ml and is equal to 93.5%. Positiye
predictive value of PSA reaches the highest value for PSA above 100 ng/ml
andisequalto79%.
Conclusions. Serial PSA determinations can replace bone scintigrqphy in
monitoring of some patients with prostate cancer during hormonal treatment.
In hormonally treated prostate cancer patients bone scintigrqphy does not have
to be performed if PSA level does not exceed 1 ng/ml as the probability of
progression is smali. This can lead to decrease in cost of monitoring
of such patients. In the group of patients with PSA above 100 ng/ml bone
scintigrqphy should be performed earlier due to high probability of progression.

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