Combined application of bone imaging and t-PSA, f-PSA, ALP in the diagnosis and treatment of bone metastases in patients with prostate cancer
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Abstract:
Objective
To explore the clinical value of combined application of bone imaging and prostate specific antigen(t-PSA), free prostate specific antigen(f-PSA) and alkaline phosphatase(ALP) in the diagnosis and treatment of prostate cancer bone metastasis.
Methods
The data of 372 patients diagnosed of prostate cancer were reviewed, and the results of the whole body bone scan and t-PSA, f-PSA, ALP were analyzed retrospectively.
Results
282 cases in 372 cases of prostate cancer were diagnosed as bone metastasis.The t-PSA, f-PSA and ALP of prostate cancer patients with metastasis were significantly higher than those of prostate cancer patients without metastasis, the difference was statistically significant (P<0.05). The sensitivity of bone imaging in the diagnosis of bone metastases was 91.84%, the specificity was 76.67%, the accuracy was 88.17%, the positive predictive value was 92.50%, the negative predictive value was 75.00%.The combined application of bone scan and serum t-PSA, f-PSA, ALP detection, the sensitivity of the diagnosis of bone metastasis of prostate cancer was 95.71%, specificity was 87.69%, accuracy was 94.36%, the positive predictive value was 87.56%, the negative predictive value was 92.22%.
Conclusion
Combined application of whole body bone scan and serum t-PSA, f-PSA, ALP detection has high sensitivity and accuracy in diagnosis of bone metastasis of prostate cancer, and it can provide reliable basis for early diagnosis, treatment and prognosis of prostate cancer.
Key words:
Prostate neoplasm; Prostate specific antigen; Free prostate specific antigen; Alkaline phosphatase; Bone metastasisObjective To explore the serum prostate specific antigen(PSA) in the diagnosis of prostate diseases.Methods Serum PSA levels of healthy control group(n=60),benign prostate disease group(n=82),and prostate cancer group(n=53) were detected by radioimmunoassay method.And the difference in serum PSA levels of prostate cancer patients was compared before and after the operation.Results The determination results showed that serum t-PSA,f-PSA and percentage of f-PSA in prostate cancer group were significantly higher than those in healthy control group,and the difference was statistically significant(P0.01).There were statistically significant differences in serum t-PSA,f-PSA and percentage of f-PSA of prostate cancer patients between before and after the operation(P0.01).Conclusions It is of great significance to detect serum PSA level in the diagnosis of prostate diseases,which is an important indicator in monitoring the therapeutic effect and evaluating the prognosis.
Prostate Diseases
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Abstract Background The early detection of bone metastases is very important in prostate cancer follow-up. This study aimed to compare conventional tumor markers, namely free prostate-specific antigen (free PSA), total prostate-specific antigen (total PSA), free PSA/total PSA ratio, alkaline phosphatase (ALP) values, Gleason scores and 99 m Tc-MDP bone scintigraphy findings in the prediction of bone metastases in prostate cancer. Methods In total, 175 patients with prostate cancer who underwent whole-body bone scintigraphy were included in the study. All selected scintigraphic studies were reprocessed. Free PSA, total PSA, free PSA/total PSA ratio, alkaline phosphatase (ALP) values and Gleason scores of patients were recorded. Results The results of our study show that the presence of bone metastasis correlates very weakly with free PSA/total PSA ratio (rho = 0.179), weakly with total PSA (rho = 0.318) and Gleason score (rho = 0.382), moderately with ALP (rho = 0.539), free PSA (0.416). Only ALP variable had a diagnostic value and ALP cutoff value was 76.50 IU/L, with 80% sensitivity and 82.1% specificity. Conclusion According to the results of our study; the free PSA, total PSA, free PSA/total PSA ratio and Gleason score values were not considered as a reliable parameter in the prostate cancer cases follow-up for bone metastasis development. Only ALP had a diagnostic value and ALP cutoff value was 76.50 IU / L with 80% sensitivity and 82.1% specificity in predicting bone metastases in prostate cancer.
Bone scintigraphy
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In this study, we aimed to test the clinical value of total prostate-specific antigen (T-PSA), free prostate-specific antigen (F-PSA), and T-PSA combined with tumor abnormal glycoprotein (TAP) for early diagnosis of prostate cancer.The levels of serum T-PSA and F-PSA were measured in 105 malignant prostate tumors and 97 benign prostate tissues using chemiluminescence immunoassay. The concentration of TAP in the serum of patients was tested by the agglutination method. Differences in PSA levels and F-PSA/T-PSA ratio in two patient groups were analyzed by t-test. TAP concentrations were compared using Chi-square test. The sensitivity, specificity, and accuracy of PSA combined with TAP for the diagnosis of prostate cancer were analyzed.The serum PSA level in patients with malignant tumors were higher than that in patients with benign tumors (P<0.0001). TAP positivity in patients with prostate cancer was higher than that in patients with benign tumors (P<0.0001). The number of cases with positive and weakly positive TAP values in three intervals of T-PSA concentrations was higher in patients with malignant tumors, while the number of negative cases was higher in patients with benign tumors (P<0.05). The sensitivity, specificity, and accuracy of T-PSA combined with TAP in the diagnosis of prostate cancer were 97.14%, 67.01%, and 81.68% respectively, which was higher compared to the other measured markers.The results of our study indicate that PSA combined with TAP is a sensitive, specific, and accurate diagnostic marker of prostate cancer. Therefore, it has potential clinical relevance for the early screening of prostate cancer.
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Nephrology
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Serum prostate specific antigen (PSA) concentration has been widely applied as a biomarker to diagnose and monitor prostate cancer. Technetium-99m methylene diphosphate (Tc-99m MDP) whole body bone scintigraphy is currently a well-accepted diagnostic procedure for bone metastasis in malignancy. The aim of this study was to establish a useful serum PSA cut-off value to predict the presence of bone metastasis in men with prostate cancer. Consecutive male patients diagnosed with prostate cancer were retrospectively analyzed. All of the subjects had received both Tc-99m MDP whole body bone scintigraphy and had their serum PSA concentration measured within 1 month. The proper cut-off value was established based on statistical analysis in order to predict the possibility of bone metastasis among prostate cancer patients. In total, 101 consecutive male patients (age, 71.92 ± 0.76 years) with prostate cancer were enrolled, and 57 patients (56%) were confirmed by scintigraphic findings to have bone metastases. A serum PSA concentration of 13 ng/mL gave the best sensitivity (96.43%) and specificity (84.09%). The area under the receiver operating characteristics curve revealed excellent discriminatory power (0.93 ± 0.02; p = 0.001). The positive predictive value, negative predictive value and likelihood ratios for positive and negative test were 88.52%, 94.87%, 6.06 and 0.04, respectively. The resulting diagnostic accuracy and odds ratio were 73.87% and 142.76. A cut-off value of 13 ng/mL appears to be an appropriate benchmark for stratifying metastatic bone disease in prostate cancer patients such that if a patient with newly diagnosed prostate cancer and without any skeletal symptoms has a serum PSA concentration of less than 13 ng/mL, we suggest that they would not need to undergo bone scintigraphy.
Bone scintigraphy
Diagnostic odds ratio
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Prostate cancer is the second most common neoplasm among men both worldwide and in Poland. In prostate cancer, bone metastasis is related to a poorer prognosis. A diagnosis of metastatic bone disease is important in prostate cancer patients prior to therapy. Prostate specific antigen (PSA) serum value is used both as a screening tool and for staging of prostate cancer.To evaluate whether there is a link between symptoms presented by patients, pain in particular, and the presence, number and location of bone metastases as assessed by bone scan scintigraphy in concordance with PSA values and Gleason scores.A group of 186 patients (aged: 68.38±6.16) diagnosed with prostate cancer, from rural and suburban areas of Małopolska province, that was directed for bone scan scintigraphy to the Nuclear Medicine Dept, John Paul II Hospital in Kraków.Analysis of all laboratory findings (including PSA value) and a biopsy were performed. Then, bone scan scintigraphy was done with the use of methylene disphosphonate (MDP) labeled with Tc-99m.In patients with a Gleason value≤7 and a PSA value≤20 ng/ml, the cutoff value for a negative bone scan with a confidence interval of 0.95 was established at a PSA value below 10 ng/ml (p<0.01). Correlations were established between PSA value and presence of metastases in bone scan (r=0.45, p=0.05), the number of metastases (r=0.66, p<0.01), and their presence in particular body regions.The correlation between PSA value and both presence and number of metastases confirms the usefulness of bone scan scintigraphy in prostate cancer staging. The cutoff value for negative bone scan with a 95% confidence interval was established at PSA=10 ng/ml.
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Cut-off
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OBJECTIVE To investigate the application value of MRI combined PSA in prostate cancer bone metastasis. METHODS 74 prostate cancer patients were selected in our hospital, patients were tested for the serum PSA level and MRI after admission to detect the expression of prostate cancer bone metastasis. RESULTS All 74 patients in our group, the positive cases of prostate cancer bone metastasis were 43 cases (58.1%), positive cases in prostate cancer bone metastasis with PSA≥ 20 μg / L group was 69.6%, significantly higher than PSA (μg / L) ﹤20 μg / L groups 22.2%, the difference had a statistical significance, P﹤0.05. CONCLUSION PSA has a good prediction effect on prostate cancer bone metastasis. When PSA≥20 μg, the probability of prostate cancer bone metastasis increases significantly. PSA≥20 μg/L combined MRI can significantly improve the detection rate in prostate cancer bone metastasis.
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The objective of the following study is to clarify a suitable group whereby a bone scan could be spared at the initial staging of prostate cancer, we wished to identify the possible relationship between bone metastasis and clinical and pathological parameters including serum total prostate specific antigen (PSA) concentration, alkaline phosphatase (ALP), biopsy Gleason Score (GS), and percentage of pathological cores.We reviewed the results of 220 bone scintigraphies, which were done between January 1, 2011 and June 30, 2013 in patients with newly diagnosed prostate cancer. These parameters were evaluated together with standard clinicopathological data to determine the prediction ability of the bone scan by univariate and multivariate analyses.Bone metastases were seen in 44 patients of all 220 patients (20%, 95% confidence interval, 17-24%). In univariate analysis, PSA and biopsy GS were useful in predicting the bone scan result, but ALP and percentage of pathological cores was not. In multivariate analysis, the single most useful parameter in predicting the bone scan result was PSA (P < 0.001).A bone scan seems to be impractical in newly diagnosed prostate cancer patients with serum PSA level <20 ng/ml and GS up to seven and pre-treatment PSA is the best predictor of the need for the bone scan according to results of this study.
Univariate analysis
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Although prostate-specific antigen (PSA) is a valuable marker of prostate cancer, some untreated patients with advanced prostate cancer have normal PSA values. Over a period of 5 years, we reviewed pretreatment serum PSA levels in 131 patients with advanced prostate cancer (stages C and D). Ten patients (7.6%) had normal PSA values. The histological type of prostate cancer associated with normal PSA values was variable and the prognosis was not so poor. Immunostaining for PSA was performed on the resected prostate tissue of the 10 patients. PSA staining was positive in 5 cases, negative in 3 cases, and equivocal in the remaining 2 cases. In conclusion, PSA is not always useful, especially for following patients with normal PSA values.
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