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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)517-523
Number of pages7
JournalWorld Journal of Urology
Volume34
Issue number4
DOIs
Publication statusPublished - Apr 1 2016

Keywords

  • Accuracy
  • Bone scintigraphy
  • CT
  • Lymph node
  • Metastasis
  • Prostate cancer
  • Staging

ASJC Scopus subject areas

  • Urology

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