Objective
To prospectively determine the prognostic value of the bone scan index (BSI) for time
to development of castration-resistant prostate cancer (CRPC) in consecutive, hormone-naïve
patients with newly diagnosed prostate cancer.
Patients and Methods
Eligible patients participated in a prospective, observational, multicenter study
of the value of bone scintigraphy (BS) at staging. BSI was determined using the EXINI
BoneBSI software in 208 consecutive patients undergoing androgen deprivation therapy. The
presence or absence of bone metastases at staging was classified by BS with or without
supplementary imaging. Follow-up was performed >5 years after including the last patient.
Results
During follow-up, 149 of the 208 patients (72%) were diagnosed with CRPC. Median time
to CRPC was 20 months. Median follow-up time was 4.4 years in patients without CRPC.
In univariate analyses, presence of bone metastases (M1) (hazard ratio [HR] 3.00,
95% confidence interval [CI] 2.10-4.30), Gleason grade (HR 1.53, 95% CI 1.31-1.79),
and BSI (HR 1.17, 95% CI 1.12-1.23) but not PSA significantly predicted time to CRPC
(all, P < .001). The predictive values of M1 (HR 2.06), Gleason grade (HR 1.47), and BSI
(HR 1.10) were confirmed in multivariate analyses. Log-rank test for equality of time
to CRPC showed the significant predictive value of BSI (BSI = 0 vs 0 < BSI ≤ 1 vs
BSI > 1, P < .001). In addition to routine assessment of M1 vs M0 status, BSI contributed to
the predictive power.
Conclusions
BSI is an independent risk factor for the time from initiation of androgen deprivation
therapy to CRPC in hormone-naïve patients. The significant prognostic factors, in
rank order, were M1 status, Gleason grade, and BSI.
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Article info
Publication history
Published online: July 28, 2017
Accepted:
May 8,
2017
Received:
March 6,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
