World Journal of Urology

, Volume 34, Issue 4, pp 517–523

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

  • D. Gabriele
  • D. Collura
  • M. Oderda
  • I. Stura
  • C. Fiorito
  • F. Porpiglia
  • C. Terrone
  • M. Zacchero
  • C. Guiot
  • P. Gabriele
Original Article

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.

Keywords

Prostate cancer CT Bone scintigraphy Staging Accuracy Lymph node Metastasis 

References

  1. 1.
    DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL et al (2014) Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 64(4):252–271CrossRefPubMedGoogle Scholar
  2. 2.
    Oderda M, Joniau S, Spahn M, Gontero P (2012) Debulking surgery in the setting of very high-risk prostate cancer scenarios. BJU Int 110(6 Pt B):E192–E198CrossRefPubMedGoogle Scholar
  3. 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
  4. 4.
    Bresciani S, Garibaldi E, Cattari G, Maggio A, Di Dia A, Delmastro E et al (2013) Dose to organs at risk in the upper abdomen in patients treated with extended fields by helical tomotherapy: a dosimetric and clinical preliminary study. Radiat Oncol 8:247CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, European Association of Urology et al (2014) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 65(1):124–137CrossRefPubMedGoogle Scholar
  6. 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
  7. 7.
    Zacho HD, Barsi T, Mortensen JC, Mogensen MK, Bertelsen H, Josephsen N et al (2014) Prospective multicenter study of bone scintigraphy in consecutive patients with newly diagnosed prostate cancer. Clin Nucl Med 39(1):26–31CrossRefPubMedGoogle Scholar
  8. 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
  9. 9.
    Pasoglou V, Larbi A, Collette L, Annet L, Jamar F, Machiels J-P et al (2014) One-step TNM staging of high-risk prostate cancer using magnetic resonance imaging (MRI): toward an upfront simplified ‘all-in-one’ imaging approach? Prostate 74(5):469–477CrossRefPubMedGoogle Scholar
  10. 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
  11. 11.
    Partin AW, Mangold LA, Lamm DM, Walsh PC, Epstein JI, Pearson JD (2001) Contemporary update of prostate cancer staging nomograms (Partin Tables) for the new millennium. Urology 58(6):843–848CrossRefPubMedGoogle Scholar
  12. 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
  13. 13.
    Isebaert S, Haustermans K, Van den Bergh L, Joniau S, Dirix P, Oyen R et al (2013) Identification and characterization of nodal metastases in prostate cancer patients at high risk for lymph node involvement. Acta Oncol 52(7):1336–1344CrossRefPubMedGoogle Scholar
  14. 14.
    D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA et al (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280(11):969–974CrossRefPubMedGoogle Scholar
  15. 15.
    Haese A, Epstein JI, Huland H, Partin AW (2002) Validation of a biopsy-based pathologic algorithm for predicting lymph node metastases in patients with clinically localized prostate carcinoma. Cancer 95(5):1016–1021CrossRefPubMedGoogle Scholar
  16. 16.
    Hövels AM, Heesakkers RAM, Adang EM, Jager GJ, Strum S, Hoogeveen YL et al (2008) The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 63(4):387–395CrossRefPubMedGoogle Scholar
  17. 17.
    Borley N, Fabrin K, Sriprasad S, Mondaini N, Thompson P, Muir G et al (2003) Laparoscopic pelvic lymph node dissection allows significantly more accurate staging in ‘high-risk’ prostate cancer compared to MRI or CT. Scand J Urol Nephrol 37(5):382–386CrossRefPubMedGoogle Scholar
  18. 18.
    Jager GJ, Barentsz JO, Oosterhof GO, Witjes JA, Ruijs SJ (1996) Pelvic adenopathy in prostatic and urinary bladder carcinoma: MR imaging with a three-dimensional TI-weighted magnetization-prepared-rapid gradient-echo sequence. AJR Am J Roentgenol 167(6):1503–1507CrossRefPubMedGoogle Scholar
  19. 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
  20. 20.
    Giannarini G, Petralia G, Thoeny HC (2012) Potential and limitations of diffusion-weighted magnetic resonance imaging in kidney, prostate, and bladder cancer including pelvic lymph node staging: a critical analysis of the literature. Eur Urol 61(2):326–340CrossRefPubMedGoogle Scholar
  21. 21.
    Dickinson L, Ahmed HU, Allen C, Barentsz JO, Carey B, Futterer JJ et al (2011) Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a European consensus meeting. Eur Urol 59(4):477–494CrossRefPubMedGoogle Scholar
  22. 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. 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
  24. 24.
    Risko R, Merdan S, Womble PR, Barnett C, Ye Z, Linsell SM et al (2014) Clinical predictors and recommendations for staging computed tomography scan among men with prostate cancer. Urology 84(6):1329–1334CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • D. Gabriele
    • 1
  • D. Collura
    • 2
  • M. Oderda
    • 3
  • I. Stura
    • 1
  • C. Fiorito
    • 3
  • F. Porpiglia
    • 4
  • C. Terrone
    • 5
  • M. Zacchero
    • 5
  • C. Guiot
    • 1
  • P. Gabriele
    • 6
  1. 1.Human Physiology Section, Neuroscience DepartmentUniversity of TorinoTurinItaly
  2. 2.Urology DivisionSan Giovanni Bosco HospitalTurinItaly
  3. 3.Urology Division, Città della Salute e della Scienza HospitalUniversity of TorinoTurinItaly
  4. 4.Urology Division, San Luigi Gonzaga HospitalUniversity of TorinoOrbassanoItaly
  5. 5.Urology DivisionUniversity of Eastern PiedmontNovaraItaly
  6. 6.Radiation Oncology DivisionFPO-IRCCS Cancer Center of CandioloCandioloItaly

Personalised recommendations