Diagnostic Correlation between Serum PSA, Gleason Score and Bone Scan Results in Prostatic Cancer Patients with Bone Metastasis

Aim: To analyse the association between serum PSA, Gleason score and bone scan results in patients with a diagnosis of prostatic carcinoma. Materials and Methods: A three years retrospective study of patients diagnosed with prostatic adenocarcinoma were reviewed to collect information about age, clinical symptoms, digital rectal examination findings, serum prostate specific antigen (PSA), Gleason score on biopsy and bone isotope scan results. We analysed the association between these clinical, pathological and radiological parameters in patients with a diagnosis of prostatic adenocarcinoma. Results: Of the 123 patients diagnosed with prostatic cancer during the 3 year study period, 72 patients with complete data were included in the study. Of the 72 patients, 15 (20.83%) presented positive scintigraphic examinations for the presence of bone metastasis. All patients who had bone metastasis on scintigraphy had PSA value of > 20 ng/mL, and in only 1 patient (0.46%) with bone metastasis PSA concentration was < 50ng/mL. There was no statistical significant correlation between PSA level and tumor grading by Gleason score and also between Gleason score and bone metastasis. Statistical analysis was performed using Chi-square (Fisher exact) test and a value of <0.05 was considered statistically significant. Conclusion: Evaluation for bone metastasis in patients with prostatic carcinoma is indicated when PSA levels are above 20ng/ml, because all patients with metastasis had a value when a PSA cut-off of >20ng/ml was considered. Though poorly differentiated prostatic carcinomas (Gleason score > 7) are known to be associated with poor prognosis with high likelihood of bone metastasis and higher serum PSA values, we did not see such association in our study.

Author(s): Kanthilatha Pai, Gauri Salgaonkar, Ranjini Kudva and Padmaraj Hegde

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