Bone Scan for Staging High-Risk Prostate Cancer
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Question
A 68-year-old man with newly diagnosed high-risk prostate cancer (PSA 45 ng/mL, Gleason 4+4) undergoes staging bone scan. Which statement about bone scan in prostate cancer staging is MOST accurate?
- ABone scan is the recommended first-line test for detecting skeletal metastases in high-risk prostate cancer
- BBone scan is only useful if PSA is >100 ng/mL
- CBone scan cannot detect prostate cancer metastases in the axial skeleton
- DA normal bone scan in prostate cancer confirms organ-confined disease
Show the answer and explanation
A. Bone scan is the recommended first-line test for detecting skeletal metastases in high-risk prostate cancer
Tc-99m MDP bone scintigraphy is the traditional recommended first-line test for detecting skeletal metastases in high-risk or symptomatic prostate cancer. Guidelines recommend bone scan for PSA >20 ng/mL, Gleason score ≥8, or T3/T4 disease. Prostate cancer produces osteoblastic metastases that are highly conspicuous on bone scan. However, Ga-68 PSMA PET/CT has greater sensitivity and is increasingly replacing bone scan for prostate cancer staging at many centers. A normal bone scan does not confirm organ-confined disease — soft tissue metastases (lymph nodes) are not detected.
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