Carcinoma of the prostate : correlation study between serum PSA level, Gleason score and presence of bone metastases on whole body scintigraphy.

Abstract

Prostate cancer is the most common cancer affecting men in Europe and the United States of America, and is the second leading cause of death in men. From various studies the increase in prostate cancer rose steadily since the 1980's and this is mainly due to the increase in life expectancy. This is also seen locally as statistical values show a tendency that the number of diagnosed patients with prostate cancer has doubled in the last seven years. This research project involves a retrospective, non-experimental, quantitative, correlational study of serum PSA level, Gleason score and the presence of bone metastases on whole body scintigraphy, in male patients over the age of 50, with elevated PSA levels, query carcinoma of the prostate, or known cases of prostate cancer. Various evaluation methods are present for the detection of prostatic carcinoma. The gold standard techniques involve; PSA which is later referred to as Total PSA to evaluate the protein level produced by the prostate, Gleason score to evaluate prostatic histological changes and radionuclide bone scintigraphy to evaluate the presence of bone metastases in patients with carcinoma of the prostate. The data gathering tool used involved a table in which the age, bone scan result, Gleason score, PSA level (ng/ml) and Computed Tomography scans of the abdomen and pelvis, were marked. The results showed that patients with a positive bone scan result, demonstrate high Gleason scores and PSA levels. The study also indicated that 50% of the patients with a negative bone scan result had PSA levels between 0.5ng/ml and 20ng/ml which could be excluded from undergoing bone scintigraphy. Other results indicate that Gleason score is not related to age while PSA has a slight tendency to increase with age. This study also concluded that when the PSA is less than 20ng/ml and Gleason score is less than four a bone scan can be omitted unless the patient complains of bone pain, while when the PSA is above 45ng/ml and the Gleason score is six or more than a bone scan is essential. Based on this study, the researcher put forward a number of recommendations such as using a larger sample size to improve the significance of the study, narrow the study by selecting only the patients diagnosed with carcinoma of the prostate. The use of a Spiral CT scanner with 5mm thick slices could lead to a better study thus leading to earlier diagnoses of prostate carcinoma and invasion to adjacent area.