Validation of a bone scan positivity risk table in non-metastatic castration-resistant prostate cancer

Stephen J. Freedland, Lauren E. Howard, Brian T. Hanyok, Vishnu K. Kadiyala, Jameson Y. Kuang, Colette A. Whitney, Floyd R. Wilks, Christopher J. Kane, Martha Kennedy Terris, Christopher L. Amling, Matthew R. Cooperberg, William J. Aronson, Daniel M. Moreira

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: To test the external validity of a previously developed risk table, designed to predict the probability of a positive bone scan among men with non-metastatic (M0) castration-resistant prostate cancer (CRPC), in a separate cohort. Patients and Methods: We retrospectively analysed 429 bone scans of 281 patients with CRPC, with no known previous metastases, treated at three Veterans Affairs Medical Centers. We assessed the predictors of a positive scan using generalized estimating equations. Area under the curve (AUC), calibration plots and decision-curve analysis were used to assess the performance of our previous model to predict a positive scan in the current data. Results: A total of 113 scans (26%) were positive. On multivariable analysis, the only significant predictors of a positive scan were log-transformed prostate-specific antigen (PSA): hazard ratio (HR) 2.13; 95% confidence interval (CI) 1.71–2.66 (P < 0.001) and log-transformed PSA doubling time (PSADT): HR 0.53; 95% CI 0.41–0.68 (P < 0.001). Among men with a PSA level <5 ng/mL, the rate of positive scans was 5%. The previously developed risk table had an AUC of 0.735 to predict positive bone scan with excellent calibration, and provided additional net benefit in the decision-curve analysis. Conclusion: We have validated our previously developed table to predict the risk of a positive bone scan among men with M0/Mx CRPC. Use of this risk table may allow better tailoring of patients' scanning to identify metastases early, while minimizing over-imaging. Regardless of PSADT, positive bone scans were rare in men with a PSA <5 ng/mL.

Original languageEnglish (US)
Pages (from-to)570-577
Number of pages8
JournalBJU International
Volume118
Issue number4
DOIs
StatePublished - Oct 1 2016

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Castration
Prostatic Neoplasms
Prostate-Specific Antigen
Bone and Bones
Decision Support Techniques
Calibration
Area Under Curve
Confidence Intervals
Neoplasm Metastasis
Veterans

Keywords

  • metastasis
  • prostate cancer
  • prostate-specific antigen
  • validation studies

ASJC Scopus subject areas

  • Urology

Cite this

Freedland, S. J., Howard, L. E., Hanyok, B. T., Kadiyala, V. K., Kuang, J. Y., Whitney, C. A., ... Moreira, D. M. (2016). Validation of a bone scan positivity risk table in non-metastatic castration-resistant prostate cancer. BJU International, 118(4), 570-577. https://doi.org/10.1111/bju.13405

Validation of a bone scan positivity risk table in non-metastatic castration-resistant prostate cancer. / Freedland, Stephen J.; Howard, Lauren E.; Hanyok, Brian T.; Kadiyala, Vishnu K.; Kuang, Jameson Y.; Whitney, Colette A.; Wilks, Floyd R.; Kane, Christopher J.; Terris, Martha Kennedy; Amling, Christopher L.; Cooperberg, Matthew R.; Aronson, William J.; Moreira, Daniel M.

In: BJU International, Vol. 118, No. 4, 01.10.2016, p. 570-577.

Research output: Contribution to journalArticle

Freedland, SJ, Howard, LE, Hanyok, BT, Kadiyala, VK, Kuang, JY, Whitney, CA, Wilks, FR, Kane, CJ, Terris, MK, Amling, CL, Cooperberg, MR, Aronson, WJ & Moreira, DM 2016, 'Validation of a bone scan positivity risk table in non-metastatic castration-resistant prostate cancer', BJU International, vol. 118, no. 4, pp. 570-577. https://doi.org/10.1111/bju.13405
Freedland SJ, Howard LE, Hanyok BT, Kadiyala VK, Kuang JY, Whitney CA et al. Validation of a bone scan positivity risk table in non-metastatic castration-resistant prostate cancer. BJU International. 2016 Oct 1;118(4):570-577. https://doi.org/10.1111/bju.13405
Freedland, Stephen J. ; Howard, Lauren E. ; Hanyok, Brian T. ; Kadiyala, Vishnu K. ; Kuang, Jameson Y. ; Whitney, Colette A. ; Wilks, Floyd R. ; Kane, Christopher J. ; Terris, Martha Kennedy ; Amling, Christopher L. ; Cooperberg, Matthew R. ; Aronson, William J. ; Moreira, Daniel M. / Validation of a bone scan positivity risk table in non-metastatic castration-resistant prostate cancer. In: BJU International. 2016 ; Vol. 118, No. 4. pp. 570-577.
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abstract = "Objectives: To test the external validity of a previously developed risk table, designed to predict the probability of a positive bone scan among men with non-metastatic (M0) castration-resistant prostate cancer (CRPC), in a separate cohort. Patients and Methods: We retrospectively analysed 429 bone scans of 281 patients with CRPC, with no known previous metastases, treated at three Veterans Affairs Medical Centers. We assessed the predictors of a positive scan using generalized estimating equations. Area under the curve (AUC), calibration plots and decision-curve analysis were used to assess the performance of our previous model to predict a positive scan in the current data. Results: A total of 113 scans (26{\%}) were positive. On multivariable analysis, the only significant predictors of a positive scan were log-transformed prostate-specific antigen (PSA): hazard ratio (HR) 2.13; 95{\%} confidence interval (CI) 1.71–2.66 (P < 0.001) and log-transformed PSA doubling time (PSADT): HR 0.53; 95{\%} CI 0.41–0.68 (P < 0.001). Among men with a PSA level <5 ng/mL, the rate of positive scans was 5{\%}. The previously developed risk table had an AUC of 0.735 to predict positive bone scan with excellent calibration, and provided additional net benefit in the decision-curve analysis. Conclusion: We have validated our previously developed table to predict the risk of a positive bone scan among men with M0/Mx CRPC. Use of this risk table may allow better tailoring of patients' scanning to identify metastases early, while minimizing over-imaging. Regardless of PSADT, positive bone scans were rare in men with a PSA <5 ng/mL.",
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AU - Kuang, Jameson Y.

AU - Whitney, Colette A.

AU - Wilks, Floyd R.

AU - Kane, Christopher J.

AU - Terris, Martha Kennedy

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AU - Cooperberg, Matthew R.

AU - Aronson, William J.

AU - Moreira, Daniel M.

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N2 - Objectives: To test the external validity of a previously developed risk table, designed to predict the probability of a positive bone scan among men with non-metastatic (M0) castration-resistant prostate cancer (CRPC), in a separate cohort. Patients and Methods: We retrospectively analysed 429 bone scans of 281 patients with CRPC, with no known previous metastases, treated at three Veterans Affairs Medical Centers. We assessed the predictors of a positive scan using generalized estimating equations. Area under the curve (AUC), calibration plots and decision-curve analysis were used to assess the performance of our previous model to predict a positive scan in the current data. Results: A total of 113 scans (26%) were positive. On multivariable analysis, the only significant predictors of a positive scan were log-transformed prostate-specific antigen (PSA): hazard ratio (HR) 2.13; 95% confidence interval (CI) 1.71–2.66 (P < 0.001) and log-transformed PSA doubling time (PSADT): HR 0.53; 95% CI 0.41–0.68 (P < 0.001). Among men with a PSA level <5 ng/mL, the rate of positive scans was 5%. The previously developed risk table had an AUC of 0.735 to predict positive bone scan with excellent calibration, and provided additional net benefit in the decision-curve analysis. Conclusion: We have validated our previously developed table to predict the risk of a positive bone scan among men with M0/Mx CRPC. Use of this risk table may allow better tailoring of patients' scanning to identify metastases early, while minimizing over-imaging. Regardless of PSADT, positive bone scans were rare in men with a PSA <5 ng/mL.

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