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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2011  |  Volume : 22  |  Issue : 5  |  Page : 1041-1043
Prostate-specific antigen level and risk of bone metastasis in Sudanese patients with prostate cancer


1 Department of Biochemistry and Nutrition, Faculty of Medicine, Institute of Nuclear Medicine, Molecular Biology and Oncology, University of Gezira, Medani, Sudan
2 Department of Oncology, Institute of Nuclear Medicine, Molecular Biology and Oncology, University of Gezira, Medani, Sudan

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Date of Web Publication6-Sep-2011
 

How to cite this article:
Khalid KE, Brair AI, Elhaj AM, Ali KE. Prostate-specific antigen level and risk of bone metastasis in Sudanese patients with prostate cancer. Saudi J Kidney Dis Transpl 2011;22:1041-3

How to cite this URL:
Khalid KE, Brair AI, Elhaj AM, Ali KE. Prostate-specific antigen level and risk of bone metastasis in Sudanese patients with prostate cancer. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2014 Nov 28];22:1041-3. Available from: http://www.sjkdt.org/text.asp?2011/22/5/1041/84565
To the Editor,

Prostate cancer is one of the major medical problems facing the male population. It represents the most common cancer diagnosed among men in the European Union in 2006, with a median age of 68 years. [1] The primary objective of clinical staging of prostate cancer is to ensure that the patient has the most appropriate treatment modality. [2]

Prostate-specific antigen (PSA) is used to monitor treatment responses, prognosis, and progression in patients with prostate cancer. [3] However, it is not sufficiently reliable to determine the clinical stage in individual patients. [4]

To determine whether serum PSA would identify a group of patients with low probability of having metastasis, we studied 150 consecutive patients (median age 73 years, range 50-90 years) newly diagnosed with prostate cancer and referred to the Department of Nuclear Medicine, Institute of Nuclear Medicine, Molecular Biology and Oncology (INMO), for bone scan, being reviewed retrospectively in the period from January to December 2008. Sixty gender- and age-matched normal subjects were used as a control group. Patients were excluded if they had previous therapy for prostatic disease, including radiation therapy or prostate surgery. Similarly, any patients with abnormal liver function or a lesion on the bone scan or patients with vesical catheter or genitourinary infection were also excluded. The diagnosis of prostate carcinoma was established through prostate biopsy. Then, all cases were submitted to bone scan scintigraphy examination. The radiologist reported on the scintigraphic exam without knowledge of the serum levels of PSA, and they were interpreted as positive or negative for bone metastasis. Serum PSA concentration was measured using an immunoradiometric assay (IMx PSA kit; Abbott Laboratories, UK). To determine the rate between PSA and the presence of bone metastasis through scintigraphy, more or less 20 ng/mL PSA was considered as the PSA reference values. Histological pattern was assessed by the Gleason score reported.

For the whole study subjects, the mean serum level of PSA was significantly higher in prostate cancer patients compared with the control group (63.55 ± 49.95 ng/mL vs. 3.98 ± 1.37 ng/mL; P <0.00) [Table 1]. Among patients with bone metastasis diagnosis, positive mean PSA concentration was significantly (P <0.01) higher compared with those without bone metastasis (84.32 ± 53.93 ng/mL vs. 47.18 ± 37.58 ng/ mL) [Table 2]. When we used PSA serum concentration ≤10 ng/mL, >10 to ≤20 ng/mL and >20 ng/mL as a cut-off point, 75 (50%) patients presented bone metastasis in scintigraphy. Of these 75 patients, four patients (2.6%) had PSA serum concentration ≤10 ng/ mL, 10 (6.7%) had PSA serum concentration >10 to ≤20 ng/mL and 61 (40.7%) had PSA concentration >20 ng/mL. The same cutting points were used for 75 (50%) patients presented without bone metastasis in scintigraphy; 25 (16.7%) patients had PSA value ≤10 ng/ mL, 12 (8.0%) had PSA serum concentration >10 to ≤20 ng/mL and 38 (25.3%) had PSA value >20 ng/mL, as given in [Table 3]. As shown in [Table 4], 62 (62.6%) of 99 patients having PSA >20 ng/mL had a high-grade score, 31 (31.3%) had an intermediate-grade score and only six (6.1%) had a low-grade score. The frequency of Gleason score was high among patients having a PSA concentration more than 20 ng/mL.
Table 1: Mean difference in PSA serum concentration between study patients and control groups.

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Table 2: Mean difference between the level of prostate-specific antigen (PSA) and the presence of bone metastasis in scintigraphy in patients with prostate cancer.

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Table 3: Relationship between prostate specific antigen (PSA) concentrations and the presence of bone metastasis in scintigraphy in patients with prostate cancer.

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Table 4: Comparison between PSA level and Gleason score.

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The PSA level correlates with the relative risk of bone metastasis. [5],[6] Our results reported a high significant difference in the mean concentration of PSA between the patients and the control group. Bone scintigraphy is the most sensitive method in the clinical practice of detecting bone metastasizes, [7],[8] and it is used frequently at the time of diagnosis.

In our study, we found that patients with a positive bone scan had a significantly high level of PSA compared with patients with negative ones. This result supports the data that the risk of positive bone scan increases with PSA. [9]

The serum PSA concentration provided little information about the presence of bone metastasis, and it was doubtful whether a staging radionuclide bone scan could be omitted in patients with a serum PSA value of <10 ng/ mL. [5],[9],[10] We found that a high frequency of patients presented with bone metastasis and had PSA >20 ng/mL as compared with those having PSA ≤10 ng/mL. It therefore appears reasonable to do without bone scanning in newly diagnosed, untreated patients with prostate cancer who have PSAs of less than or equal to 10 ng/mL. Many clinician now limit bone scans to men with a pre-operative PSA level of >20 ng/mL and/or bony symptoms, provided the Gleason score is <7. In our study, Gleason score was found to be high among patients with serum PSA >20 ng/mL, as others. [11]

In conclusion, PSA level correlates with the bone scan result, although all staging bone scan studies in patients with newly diagnosed, un-treated prostate cancer and low serum PSA level are retrospective and consequently may be prone to a possible selection bias.

 
   References Top

1.Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 2007;18(3):581-92.  Back to cited text no. 1
    
2.Ries LA, Melbert D, Krapcho M. SEER Cancer Statistics Review, 1975-2004. National cancer Institute, Bethesda, MD, USA, November 2006. 2  Back to cited text no. 2
    
3.Papsiderol LD, Kuriyama M, Wang M. Prostate antigen: Marker for human prostate epithelial cells. J Nat Cancer Inst 1981;66:37-42.  Back to cited text no. 3
    
4.Oesterling JE. Prostate specific antigen: a critical assessment of the most useful tumor marker for adenocarcinoma of the prostate. J Urol 1991;145: 907-23.  Back to cited text no. 4
[PUBMED]    
5.Chybowski FM, Larson Keller JJ, Bergstralh EJ, Oesterling JE. Predicting radionuclide bone scan fndings in patients with newly diagnosed, untreated prostate cancer: Prostate specifc antigen is superior to all other clinical parameters. J Urol 1991;145:313-8.  Back to cited text no. 5
    
6.Miller PD, Eardley I, Kirby RS. Prostate specific antigen and bone scan correlation in the staging and monitoring of patients with prostatic cancer. Br J Urol 1992;70: 295-8.  Back to cited text no. 6
[PUBMED]    
7.Terris MK, Klonecke AS, McDougall IR, Stamey TA. Utilization of bone scans in conjunction with prostate specific antigen levels in the surveillance for recurrence of adenocarcinoma after radical prostatectomy. J Nucl Med 1991;32:1713-7.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Gerber G, Chodak GW. Assessment of value of routine bone scans in patients with newly diagnosed prostate cancer. Urology 1991;37: 418-22.  Back to cited text no. 8
[PUBMED]    
9.Oesterling JE, Martin SK, Bergstrahl EJ, Lowe FC. The use of prostate-specific antigen in staging patients with newly diagnosed prostate cancer. JAMA 1993;269:57-60.  Back to cited text no. 9
    
10.Wolff JM, Zimny M, Borchers H, Wildberger J, Buell U, Jakse G. Is prostate-specifc antigen a reliable marker of bone metastasis in patients with newly diagnosed cancer of the prostate? Eur Urol 1998;33:376-81.  Back to cited text no. 10
[PUBMED]    
11.Epstein JI, Partin AW, Sauvageot J, Walsh PC. Prediction of progression following radical Prostatectomy. A multivariate analysis of 721 men with long-term follow- up. Am J Surg Pathol 1996;20:280-92.  Back to cited text no. 11
    

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Correspondence Address:
Khalid Eltahir Khalid
Department of Biochemistry and Nutrition, Faculty of Medicine, Institute of Nuclear Medicine, Molecular Biology and Oncology, University of Gezira, Medani
Sudan
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PMID: 21912047

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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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