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For each needle biopsy, certain variables were assessed, including GS, the percentage of tumor as a function of all the biopsy tissues, the number of cancer-positive cores, and the total number of cores from all biopsy sites. All biopsy specimens were reviewed by experienced pathologists in accordance with the standard Gleason grading criteria. The percentages of biopsy cores positive were grouped as ��33%, 34-67%, and >67%. The assigned percentage of biopsy core-positive subgroups along with Smoothened inhibitor pre-treatment PSA and GS were used to develop probability for pathologic bone scan. At least 2 h after the intravenous injection of 740 MBq (20 mCi) 99mTc-MDP, whole-body bone scan images were obtained on the anterior and posterior projections, if necessary together with oblique or lateral static images for areas of interest, using a large-field of view, dual-head gamma camera (ECAM; Dual Head Variable Systems, Siemens, Illinois, USA) equipped with high-resolution collimator. All scans were reported by experienced nuclear Selleckchem Plerixafor medicine specialists with knowledge of clinical and laboratory findings, regardless of the PSA level at diagnosis, GS, clinical T stage and symptom. The relationship between the serum PSA, ALP, GS, percentage of positive biopsy cores and the result of the bone scan was examined by calculating series of crude, stratified, and adjusted odd ratios (OR) (three of four factors aforementioned held constant when calculating the OR in the multivariate analysis) with corresponding 95% confidence intervals (95% CI). The groupings were based on previous papers on this subject published on journals with high impact factors.[8,9] Multivariate analysis was performed to the variables with P of positive bone Phosphorylase metastases were evaluated by PSA level at diagnosis, GS and percent of positive cores (PPC) of biopsy. Two-sided t-tests were used to compare the continuous parameters. Univariate and multivariate logistic regression analyses were performed to assess the predictors of patients with positive bone metastasis. In addition, for PSA values, a receiver operating characteristic (ROC) analysis was performed and data are given as area under the curve (AUC) with 95% CI and significance levels. RESULTS Two hundred twenty consecutive newly diagnosed prostate cancer patients were included in the analysis. Forty-four patients had a positive scan indicative of metastatic disease (20%, 95% CI, 17-24%). Median age of patients with and without bone metastasis was 69.2 and 64.7 years old, respectively (P = 0.