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Die Skelettszintigraphie beim neu diagnostizierten Prostatakarzinom

Klinische Aspekte und Kostenanalyse

Radionuclide bone scan in patients with newly diagnosed prostate cancer

Clinical aspects and cost analysis

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Zusammenfassung

Hintergrund

Die Indikationsstellung zur Skelettszintigraphie beim neu diagnostizierten, unbehandelten Prostatakarzinom ist kontrovers.

Patienten und Methoden

In der vorliegenden retrospektiven Studie untersuchten wir 406 Patienten, die unabhängig von PSA-Wert und Histologie eine Staging-Skelettszintigraphie erhielten. Aus dem Patientengut evaluierten wir verschiedene Leitlinien und Empfehlungen bezüglich ihrer Vorhersagekraft. Die Kosten wurden gemäß EBM und GOÄ kalkuliert. Bei der Klassifikation von Skelettmetastasen prüften wir die Einteilungen nach Soloway, Crawford und Rigaud.

Ergebnisse

Eine positive Skelettszintigraphie im Sinne einer Skelettmetastasierung fanden wir bei 41 (10%) der 406 Patienten. Die Leitlinie der EAU hat sich sowohl hinsichtlich ihrer klinischen Wertigkeit als auch der Kosteneffizienz als wertvollste Empfehlung herausgestellt. Als Klassifikationssystem erwies sich die Rigaud-Klassifikation den anderen Einteilungen überlegen.

Schlussfolgerung

Gemäß der EAU-Leitlinie 2005 scheint die Skelettszintigraphie bei asymptomatischen Patienten mit einem PSA>20 ng/ml (G1/G2) sowie unabhängig vom PSA-Wert bei einem G3-Karzinom und lokal fortgeschrittenem Tumor indiziert. Als bestes Klassifikationssystem für Skelettmetastasen im Skelettszintigramm erwies sich die Einteilung nach Rigaud.

Abstract

Background

The indication for a radionuclide bone scan in patients with newly diagnosed, untreated prostate cancer remains controversial.

Patients and methods

In this retrospective study we examined 406 patients who had received a staging bone scan irrespective of their PSA serum level and histology. We evaluated different guidelines and recommendations with respect to their usefulness. The costs were calculated according to EBM and GOÄ. We evaluated the classification systems of bone metastases according to Soloway, Crawford, and Rigaud.

Results

The bone scan was positive in 41 (10%) of 406 patients. The EAU guidelines turned out to be useful with respect to both clinical value and cost efficiency. The Rigaud classification of bone metastases predicted outcome better than the Soloway or Crawford classification.

Conclusions

The EAU guidelines from 2005 are a useful tool to decide whether to perform a bone scan in patients with newly diagnosed, untreated prostate cancer. A bone scan should be performed if PSA levels exceed 20 ng/ml in patients with a G1/G2 histology, and in patients with G3 histology and locally advanced disease irrespective of PSA level. Bone scan metastases should be classified according to Rigaud.

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Authors and Affiliations

  1. Urologische Gemeinschaftspraxis, Magdeburg

    T. Klatte & D. Klatte

  2. Urologische Gemeinschaftspraxis, Dillenburg

    M. Böhm

  3. Urologische Klinik, Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg

    T. Klatte & E. P. Allhoff

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  1. T. Klatte
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  2. D. Klatte
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Correspondence to T. Klatte.

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Klatte, T., Klatte, D., Böhm, M. et al. Die Skelettszintigraphie beim neu diagnostizierten Prostatakarzinom. Urologe 45, 1293–1299 (2006). https://doi.org/10.1007/s00120-006-1078-7

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  • DOI: https://doi.org/10.1007/s00120-006-1078-7

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