Are serial bone scans useful for the follow-up of clinically localized, low to intermediate XXXX managed with watchful observation alone?

@entity1 @entity1486 @entity263 @entity3
OBJECTIVE: To assess the predictive value of serial bone scans as a surveillance tool for bone @entity3 in @entity1 with clinically localized @entity263 and managed with watchful observation. @entity1 AND METHODS: A prospective single-arm study was conducted to assess the feasibility of a watchful observation protocol with selective delayed intervention for @entity1 with clinically localized @entity263 , i.e. T1b-T2bN0M0, a Gleason score of <or= 7 and a @entity1486 (PSA) level of <or= 15 ng/mL. @entity1 were managed expectantly as long as they did not meet the empirically predefined criteria of clinical, histological or PSA progression. Bone scintigraphy was repeated every year for the first 2 years, then every 2 years thereafter if the @entity1 remained on watchful observation. When the follow-up PSA level was > 15 ng/mL the @entity1 underwent bone scintigraphy every year. RESULTS: In all, 244 eligible @entity1 were enrolled into the study. With a median follow-up of 30 months, 449 bone scans were taken (150 at baseline and 299 in follow-up evaluations); all 299 follow-up scans were negative for bone @entity3 . Hence, the true rate of positive follow-up bone scans was estimated to be 0-1.0% (95% confidence). In all, 171 @entity1 had at least one follow-up bone scan; of these, the number (%) of @entity1 who had 1, 2, 3, 4 and >or= 5 follow-up scans was 89 (52), 53 (31), 17 (10), eight (4.7) and four (2.3), respectively. The PSA levels (ng/mL) corresponding to all follow-up bone scans were: 214 scans at PSA < 10, 61 at 10-14.9, 18 at 15-19.9 and six at >or= 20 (range 20.2-24.9). The probability of a negative bone scan was estimated to be 88-100% (95% confidence interval) when a PSA threshold of 15 ng/mL was used. CONCLUSION: The probability of positive findings in serial bone scans in untreated, localized, low to intermediate @entity263 was low when the follow-up PSA level remained < 15 ng/mL. Avoiding bone scans in this group of @entity1 would translate into a significant cost saving and reduction in their psychological and physical burden. As for those with a follow-up PSA of> 15 ng/mL, the role of serial bone scintigraphy remains undefined, as a longer follow-up and a larger sample are needed.
