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Bone histology at autopsy and matched bone scintigraphy findings in patients with hormone refractory prostate cancer: the effect of bisphosphonate therapy on bone scintigraphy results
J.A. Smith / Urologic Oncology: Seminars and Original Investigations 21 (2003) 480 – 491
483
Commentary The conclusion of this manuscript—that intermittent androgen suppression is feasible—is not in doubt. Further, it may offer some quality of life advantages. Unfortunately, randomized studies so far have not shown any apparent improvement in overall biochemical progression rates. doi:10.1016/S1078-1439(03)00158-3 Joseph A. Smith, M.D.
Bone histology at autopsy and matched bone scintigraphy findings in patients with hormone refractory prostate cancer: the effect of bisphosphonate therapy on bone scintigraphy results. Roudier MP, Vesselle H, True LD, Higano CS, Ott SM, King SH, Vessella RL, Department of Urology, University of Washington, Seattle, WA. Clin Exp Metastasis 2003;20:171–180. Bisphosphonates (BisP) are nonmetabolized compounds with high-bone affinity used in bone metastasis diagnosis and treatment. Currently, BisP are used to treat hypercalcemia of malignancy as well as to prevent, minimize, or delay skeletal morbidity. These compounds have a long half-life in bone. Thus, long-term BisP treatment might saturate bone and interfere with a single-dose scanning agent used for bone scintigraphy when visualizing bone metastases. In an effort to answer this question, this study evaluated the concordance of histology and Technetium99 methylene diophosphonate (Tc99 MDP) bone scintigraphy in the diagnosis of bone metastases in prostate cancer patients. We assessed the concordance of findings between bone scintigraphy and histology using 188 bone biopsies from 11 autopsied patients who died with metastatic prostate cancer, 5 of whom were treated with pamidronate for 2 to 13 months before death. Overall agreement between histology and bone scintigraphy was 84%, 86% in nonpamidronate-treated patients and 82% in pamidronate-treated patients. Scintigraphic bone metastases without histological metastasis (false negatives ⫽ 12.7%) were observed in 24 anatomic locations; half of these were in one patient who had been treated with pamidronate and had no histological bone response to the carcinoma. There were only 4 sites where a positive bone scan was not associated with histologic metastasis (false positives ⫽ 2.21%). There was no statistical difference between the treated and nontreated group for concordance, specificity, sensitivity, positive and negative predictive values of bone scintigraphy and prevalence of histological abnormality. Long-term pamidronate treatment of prostate cancer bone metastases does not generally affect the ability to detect bone metastases with Tc99 MDP bone scintigraphy.
Commentary There were two particularly interesting findings from this innovative study that correlated bone scan findings with histologic evidence of metastasis at autopsy and explored the potential influence of bisphosphonate therapy. First, the overall false positive rate for sites found to be abnormal on bone scan but negative histologically was extremely low (2%). Further, the use of bisphosphonate therapy did not appear to alter the findings despite the known bone metabolic effects of bisphosphonates. doi:10.1016/S1078-1439(03)00157-1 Joseph A. Smith, M.D.
Trends in prostate cancer mortality among black men and white men in the United States. Chu KC, Tarone RE, Freeman HP, Center to Reduce Cancer Health Disparities, National Cancer Institute, Bethesda, MD. Cancer 2003;97:1507–1516. Background: Prostate cancer mortality rates in the United States declined sharply after 1991 in White men and declined after 1992 in African American men. The current study was conducted to investigate possible mechanisms for the declining prostate cancer mortality rates in the United States. Methods: The authors examined and compared patterns of prostate cancer incidence, survival rates, and mortality rates among African American men and White men in the United States using the 1969 –1999 U.S. prostate cancer mortality rates and the 1975–1999 prostate cancer incidence, survival, and incidence-based mortality rates from the Surveillance, Epidemiology, and End Results (SEER) Program for the U.S. population. The SEER data represent approximately 10% of the U.S. population. Results: Prostate cancer incidence and mortality rates showed transient increases after 1986, when the U.S. Food and Drug Administration approved the use of prostate specific antigen (PSA) testing. The age-adjusted prostate cancer mortality rates for men age 50 to 84 years, however, have dropped below the rate in 1986 since 1995 for White men and since 1997 for African American men. In fact, for White men ages 50 –79 years, the 1998 and 1999 rates were the lowest observed since 1950. Incidence-based mortality rates by disease stage revealed that the recent declines were because of declines in distant disease mortality. Moreover, the decrease in distant disease mortality was because of a decline in distant disease incidence, and not to improved survival of patients with distant disease. Conclusions: Similar incidence, survival, and mortality rate patterns are seen in African American men and White men in the United States, although with differences in the timing and magnitude of recent rate decreases. Increased detection of prostate cancer before it becomes metastatic, possibly reflecting increased use of PSA testing after 1986, may explain much of the recent mortality decrease in both white men and black men.
483
Commentary The conclusion of this manuscript—that intermittent androgen suppression is feasible—is not in doubt. Further, it may offer some quality of life advantages. Unfortunately, randomized studies so far have not shown any apparent improvement in overall biochemical progression rates. doi:10.1016/S1078-1439(03)00158-3 Joseph A. Smith, M.D.
Bone histology at autopsy and matched bone scintigraphy findings in patients with hormone refractory prostate cancer: the effect of bisphosphonate therapy on bone scintigraphy results. Roudier MP, Vesselle H, True LD, Higano CS, Ott SM, King SH, Vessella RL, Department of Urology, University of Washington, Seattle, WA. Clin Exp Metastasis 2003;20:171–180. Bisphosphonates (BisP) are nonmetabolized compounds with high-bone affinity used in bone metastasis diagnosis and treatment. Currently, BisP are used to treat hypercalcemia of malignancy as well as to prevent, minimize, or delay skeletal morbidity. These compounds have a long half-life in bone. Thus, long-term BisP treatment might saturate bone and interfere with a single-dose scanning agent used for bone scintigraphy when visualizing bone metastases. In an effort to answer this question, this study evaluated the concordance of histology and Technetium99 methylene diophosphonate (Tc99 MDP) bone scintigraphy in the diagnosis of bone metastases in prostate cancer patients. We assessed the concordance of findings between bone scintigraphy and histology using 188 bone biopsies from 11 autopsied patients who died with metastatic prostate cancer, 5 of whom were treated with pamidronate for 2 to 13 months before death. Overall agreement between histology and bone scintigraphy was 84%, 86% in nonpamidronate-treated patients and 82% in pamidronate-treated patients. Scintigraphic bone metastases without histological metastasis (false negatives ⫽ 12.7%) were observed in 24 anatomic locations; half of these were in one patient who had been treated with pamidronate and had no histological bone response to the carcinoma. There were only 4 sites where a positive bone scan was not associated with histologic metastasis (false positives ⫽ 2.21%). There was no statistical difference between the treated and nontreated group for concordance, specificity, sensitivity, positive and negative predictive values of bone scintigraphy and prevalence of histological abnormality. Long-term pamidronate treatment of prostate cancer bone metastases does not generally affect the ability to detect bone metastases with Tc99 MDP bone scintigraphy.
Commentary There were two particularly interesting findings from this innovative study that correlated bone scan findings with histologic evidence of metastasis at autopsy and explored the potential influence of bisphosphonate therapy. First, the overall false positive rate for sites found to be abnormal on bone scan but negative histologically was extremely low (2%). Further, the use of bisphosphonate therapy did not appear to alter the findings despite the known bone metabolic effects of bisphosphonates. doi:10.1016/S1078-1439(03)00157-1 Joseph A. Smith, M.D.
Trends in prostate cancer mortality among black men and white men in the United States. Chu KC, Tarone RE, Freeman HP, Center to Reduce Cancer Health Disparities, National Cancer Institute, Bethesda, MD. Cancer 2003;97:1507–1516. Background: Prostate cancer mortality rates in the United States declined sharply after 1991 in White men and declined after 1992 in African American men. The current study was conducted to investigate possible mechanisms for the declining prostate cancer mortality rates in the United States. Methods: The authors examined and compared patterns of prostate cancer incidence, survival rates, and mortality rates among African American men and White men in the United States using the 1969 –1999 U.S. prostate cancer mortality rates and the 1975–1999 prostate cancer incidence, survival, and incidence-based mortality rates from the Surveillance, Epidemiology, and End Results (SEER) Program for the U.S. population. The SEER data represent approximately 10% of the U.S. population. Results: Prostate cancer incidence and mortality rates showed transient increases after 1986, when the U.S. Food and Drug Administration approved the use of prostate specific antigen (PSA) testing. The age-adjusted prostate cancer mortality rates for men age 50 to 84 years, however, have dropped below the rate in 1986 since 1995 for White men and since 1997 for African American men. In fact, for White men ages 50 –79 years, the 1998 and 1999 rates were the lowest observed since 1950. Incidence-based mortality rates by disease stage revealed that the recent declines were because of declines in distant disease mortality. Moreover, the decrease in distant disease mortality was because of a decline in distant disease incidence, and not to improved survival of patients with distant disease. Conclusions: Similar incidence, survival, and mortality rate patterns are seen in African American men and White men in the United States, although with differences in the timing and magnitude of recent rate decreases. Increased detection of prostate cancer before it becomes metastatic, possibly reflecting increased use of PSA testing after 1986, may explain much of the recent mortality decrease in both white men and black men.