| Prostate cancer is a common malignant tumor among elderly men. Themorbidity rate has gradually increased in China and abroad, which ranked No.1among male malignant tumors in Europe and America, and ranked No.6inChina. Radical prostatectomy is an effective therapeutic method, but themorbidity rate of osseous metastasis after operation is high. Osseousmetastasis is not easy to detect in the early stage, furthermore, it will impactthe patient’s living and lifetime seriously. Therefore，an accurate diagnosis ofosseous metastasis at the early stage for prostate cancer sufferers afterprostatectomy operation is definitely important in the clinic treatment.At present, the radionuclide bone imaging examination is normallyadopted to diagnose osseous metastasis of prostate cancer at present. Theradionuclide bone imaging will reflect the condition of local blood supply andbone metabolism, with high sensitivity, early detection and low rate ofmisdiagnosis through the whole body imaging. Most hospitals make it the firstchoice in diagnosing osseous metastasis of prostate cancer. But the specificityof bone imaging is relatively weak, which would result in a difficulty indistinguish the cancer easily from fracture, retrogression or other benignlesion.Serum PSA is the organ-specific markers of prostate cancer. The positiverate of prostate cancer, which rises in advanced phase, combined with thegeneral investigation of rectum indication, is widely used in clinic treatmentand so far is recognized as an effective first-line therapy to diagnose prostatecancer. While the serum TPSA and FPSA are in the low concentration, itwould overlap with the benign prostatic hyperplasia, liable to be influenced byvarious operations (cystoscope，urethral catheterization, etc). ALP mainly derived from liver, bone, placenta, and small intestine, etc. Itis one of the biochemical indexes of early application in research andmonitoring of prostate cancer in patients with bone metastasis, can reliablyreflect the osteogenic activity.Currently, no single effective measure is found to predict osseousmetastasis of prostate cancer at the early stage exactly through noninvasiveway. Through relating various detection means to the degree of osseousmetastasis in the analysis, this experiment aims to guide the clinical workeffectively.Objective:Through the nuclide bone imaging and the test of serum PSA and ALP ofthe postoperative prostate cancer patients, this research aims to analyze therelativity between whole body bone imaging on PSA and ALP, discuss thevalue of these data to the diagnosis of osseous metastasis of postoperativeprostate cancer, demonstrate the feasibility of using the combination tumormarker in the whole body bone imaging and ALP to detect the curative effectafter prostate cancer operation, and thus to provide experimental basis forclinical diagnosis and treatment.Methods:To make a retrospective study of the nuclide bone imaging, serum PSAand ALP result on the59prostate cancer patients who have received operationtreatments in our hospital from January2011to December2011; and makepost-operation follow-ups in the6thmonth and12thmonth, to test thewhole-body bone imaging and serological examination including PSA, ALP,etc, and carry out the relativity analysis of the osseous metastasis degree, theserum PSA degree and the ALP value.1.99mTc-MDP whole-body bone imagingThe dosage of the99mTc-MDP which the patient had intravenous injectedwas555-925MBq99mTc-MDP15-25mCi, and the whole-body bone imaging ingeneral anteroposterior position was made3hour later. The bone imaging diagnoses were read and discriminated by twoexperienced attending doctors. Under the guidance of soloway gradingstandard, the bone imaging was dived into four levels in accordance with thenumber and degree of the main osseous metastasis nidus: level0is normalbone imaging or benign lesion, level1contains1～2metastasis nidus, level2contains3～5metastasis nidus, level3contains5more metastasis nidus or thewhole body lesion.The osseous metastasis is jointly diagnosed by the bone imaging, CT,X-ray or the pathological examination result.2. Serological examination3ml elbow venous blood was collected from the patient with an emptystomach in the morning, and the serum was separated to measure the serumTPSA and ALP.The indexes above were observed in accordance with the normalreference value of the related index in the PRC professional standardWH/T44-2012.Results:Among the59prostate cancer samples, the incidence rate of osseousmetastasis is72.9%(43/59), and the most common metastasis parts are spineand pelvis. Positive bone scan before there was a significant differencebetween groups (t=-6.36, P <0.05) and negative treatment serum PSA levels.After6months of treatment serum PSA levels were significantly reduced, butbone scintigraphy remains positive and negative groups was significantdifference (t=-0.23, P <0.05). After12months of treatment PSA levelstended to increase bone scintigraphy positive group and negative groupdifference was statistically significant (t=-2.08, P <0.05).6months aftertreatment with PSA levels after treatment compared to12months, there was asignificant difference (t=-2.16, P <0.05) between the two.59patients beforetreatment and after6months,12months, mean ALP patients were (348.50±37.15) U/L,(220.85±20.41) U/L,(276.01±25.08) U/L, F=5.069, P=0.007<0.05statistically significant, there was significant difference compared with the postoperative6months and12months ago ALP value of preoperativeand postoperative values greater than preoperative ALP; ALP value after sixmonths and no significant difference after12months compared. Before andafter treatment of bone metastasis-positive and negative groups ALP levelswere significantly different (t=-5.46, P <0.05),(t=-3.82, P <0.05),(t=-4.17,P <0.05). Before treatment,59cases of prostate cancer PSA, ALP and twomarkers in bone metastasis-positive test rates were97.8%,72.1%,100%andsensitivity were81.0%,90.3%,93.3%, and two markers in a single projectthere are significant differences compared (P <0.05),52.9%specificity results,42.9%,57.1%, compared with the two markers in a single project wasstatistically significant (P <0.05). After6months of treatment testing positiverate was89.4%,61.7%,93.6%after12months of treatment was100%,81.6%and100%. After6months of treatment sensitivity results:90.5%,96.6%,97.7%and specificity of results:52.9%,62.3%,33.3%. After12months oftreatment with a sensitivity of85.7%,95.0%,97.7%and specificity of70.0%,57.9%,6.7%. After treatment, PSA, ALP two markers in PCa bone metastasescompared with the sensitivity and specificity of detection but the project wassignificantly higher (P <0.05).The Spearman correlation analysis of thepatients’ osseous metastasis situation with TPSA, ALP shows that the PSAlevel has a positive correlation with the osseous metastasis degree before andafter treatment (r1=0.563, r2=0.716, r3=0.564), ALP level before treatmentand after6months,12months,also has a good linear correlation with theosseous metastasis degree r=0.861，r=0.844，r=0.824。Conclusion:At present, radionuclide bone imaging is still the main method todiagnose osseous metastasis of prostate cancer. ALP level is related to theseverity of osseous metastasis. The patients preliminarily diagnosed as havingprostate cancer, with their PSA≥20ng/ml, should be examined by normalbone imaging. After treatment, with PSA≥0.4ng/ml, bone imagingexamination would be used. If the bone scanning is suspected to be osseousmetastasis of prostate cancer, a serological test is to be applied at the same time, to improve the diagnosis accuracy and contribute to the treatment andclinical observation of osseous metastasis of prostate cancer. |
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