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Is there still a role for computed tomography and bone scintigraphy in prostate cancer staging? An analysis from the EUREKA-1 database

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Abstract

Purpose

According to the current guidelines, computed tomography (CT) and bone scintigraphy (BS) are optional in intermediate-risk and recommended in high-risk prostate cancer (PCa). We wonder whether it is time for these examinations to be dismissed, evaluating their staging accuracy in a large cohort of radical prostatectomy (RP) patients.

Methods

To evaluate the ability of CT to predict lymph node involvement (LNI), we included 1091 patients treated with RP and pelvic lymph node dissection, previously staged with abdomino-pelvic CT. As for bone metastases, we included 1145 PCa patients deemed fit for surgery, previously staged with Tc-99m methylene diphosphonate planar BS.

Results

CT scan showed a sensitivity and specificity in predicting LNI of 8.8 and 98 %; subgroup analysis disclosed a significant association only for the high-risk subgroup of 334 patients (P 0.009) with a sensitivity of 11.8 % and positive predictive value (PPV) of 44.4 %. However, logistic multivariate regression analysis including preoperative risk factors excluded any additional predictive ability of CT even in the high-risk group (P 0.40). These data are confirmed by ROC curve analysis, showing a low AUC of 54 % for CT, compared with 69 % for Partin tables and 80 % for Briganti nomogram. BS showed some positivity in 74 cases, only four of whom progressed, while 49 patients with negative BS progressed during their follow-up, six of them immediately after surgery.

Conclusions

According to our opinion, the role of CT and BS should be restricted to selected high-risk patients, while clinical predictive nomograms should be adopted for the surgical planning.

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Authors’ contributions

Gabriele D involved in project development, data collection and data management. Collura D, Fiorito C, Porpiglia F, Terrone C and Zacchero M involved in data collection. Oderda M and Stura I involved in data management. Guiot C and Gabriele P involved in project development.

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Authors and Affiliations

  1. Human Physiology Section, Neuroscience Department, University of Torino, Corso Raffaello 30, 10125, Turin, Italy

    D. Gabriele, I. Stura & C. Guiot

  2. Urology Division, San Giovanni Bosco Hospital, Turin, Italy

    D. Collura

  3. Urology Division, Città della Salute e della Scienza Hospital, University of Torino, Turin, Italy

    M. Oderda & C. Fiorito

  4. Urology Division, San Luigi Gonzaga Hospital, University of Torino, Orbassano, Italy

    F. Porpiglia

  5. Urology Division, University of Eastern Piedmont, Novara, Italy

    C. Terrone & M. Zacchero

  6. Radiation Oncology Division, FPO-IRCCS Cancer Center of Candiolo, Candiolo, Italy

    P. Gabriele

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  1. D. Gabriele
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  2. D. Collura
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  3. M. Oderda
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  4. I. Stura
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  7. C. Terrone
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  8. M. Zacchero
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  9. C. Guiot
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  10. P. Gabriele
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Corresponding author

Correspondence to D. Gabriele.

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Conflict of interest

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Ethical standard

EUREKA-1 study was approved by the Ethical Committee of FPO-IRCCS Cancer Center of Candiolo in July 2013 and amended in November 2014.

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Gabriele, D., Collura, D., Oderda, M. et al. Is there still a role for computed tomography and bone scintigraphy in prostate cancer staging? An analysis from the EUREKA-1 database. World J Urol 34, 517–523 (2016). https://doi.org/10.1007/s00345-015-1669-2

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  • DOI: https://doi.org/10.1007/s00345-015-1669-2

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