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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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.
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.
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.
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.
KeywordsProstate cancer CT Bone scintigraphy Staging Accuracy Lymph node Metastasis
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.
Compliance with ethical standards
Conflict of interest
EUREKA-1 study was approved by the Ethical Committee of FPO-IRCCS Cancer Center of Candiolo in July 2013 and amended in November 2014.
- 3.Garibaldi E, Cattari G, Gabriele D, Delmastro E, Carau B, Cutaia C et al (2013) A personalized treatment with image-guided intensity modulated radiotherapy for high-very high risk and metastatic prostate cancer patients: preliminary results. Trends Cancer Res 9:33–42Google Scholar
- 6.Mohler JL, Kantoff PW, Armstrong AJ, Bahnson RR, Cohen M, D’Amico AV, National Comprehensive Cancer Network et al (2014) Prostate cancer, version 2.2014. J Natl Compr Cancer Netw 12(5):686–718Google Scholar
- 8.Briganti A, Abdollah F, Nini A, Suardi N, Gallina A, Capitanio U et al (2012) Performance characteristics of computed tomography in detecting lymph node metastases in contemporary patients with prostate cancer treated with extended pelvic lymph node dissection. Eur Urol 61(6):1132–1138CrossRefPubMedGoogle Scholar
- 10.Lecouvet FE, El Mouedden J, Collette L, Coche E, Danse E, Jamar F et al (2012) Can whole-body magnetic resonance imaging with diffusion-weighted imaging replace Tc 99m bone scanning and computed tomography for single-step detection of metastases in patients with high-risk prostate cancer? Eur Urol 62(1):68–75CrossRefPubMedGoogle Scholar
- 12.Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N et al (2012) Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol 61(3):480–487CrossRefPubMedGoogle Scholar
- 19.McLoughlin LC, O’Kelly F, O’Brien C, Sheikh M, Feeney J, Torreggiani W et al (2014) The improved accuracy of planar bone scintigraphy by adding single photon emission computed tomography (SPECT-CT) to detect skeletal metastases from prostate cancer. Ir J Med Sci. doi: 10.1007/s11845-014-1228-7 PubMedGoogle Scholar
- 22.Evangelista L, Guttilla A, Zattoni F, Muzzio PC, Zattoni F (2013) Utility of choline positron emission tomography/computed tomography for lymph node involvement identification in intermediate- to high-risk prostate cancer: a systematic literature review and meta-analysis. Eur Urol 63(6):1040–1048CrossRefPubMedGoogle Scholar
- 23.Briganti A, Passoni N, Ferrari M, Capitanio U, Suardi N, Gallina A et al (2010) When to perform bone scan in patients with newly diagnosed prostate cancer: external validation of the currently available guidelines and proposal of a novel risk stratification tool. Eur Urol 57(4):551–558CrossRefPubMedGoogle Scholar