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Bone Scan Index: a prognostic imaging biomarker for high-risk prostate cancer patients receiving primary hormonal therapy

Reza Kaboteh1*, Jan-Erik Damber2, Peter Gjertsson1, Peter Höglund3, Milan Lomsky1, Mattias Ohlsson4 and Lars Edenbrandt15

Author Affiliations

1 Department of Molecular and Clinical Medicine, Clinical Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, 413 45, Sweden

2 Department of Urology, Institute of Clinical Sciences, Gothenburg University, Gothenburg, 413 45, Sweden

3 Competence Centre for Clinical Research, Lund University Hospital, Lund, 221 00, Sweden

4 Department of Theoretical Physics, Lund University, Lund, 221 00, Sweden

5 Department of Clinical Sciences, Malmö, Lund University, Lund, 221 00, Sweden

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EJNMMI Research 2013, 3:9  doi:10.1186/2191-219X-3-9

Published: 6 February 2013



The objective of this study was to explore the prognostic value of the Bone Scan Index (BSI) obtained at the time of diagnosis in a group of high-risk prostate cancer patients receiving primary hormonal therapy.


This was a retrospective study based on 130 consecutive prostate cancer patients at high risk, based on clinical stage (T2c/T3/T4), Gleason score (8 to 10) and prostate-specific antigen (PSA) (> 20 ng/mL), who had undergone whole-body bone scans < 3 months after diagnosis and who received primary hormonal therapy. BSI was calculated using an automated method. Cox proportional-hazards regression models were used to investigate the association between clinical stage, Gleason score, PSA, BSI and survival. Discrimination between prognostic models was assessed using the concordance index (C-index).


In a multivariate analysis, Gleason score (p = 0.01) and BSI (p < 0.001) were associated with survival, but clinical stage (p = 0.29) and PSA (p = 0.57) were not prognostic. The C-index increased from 0.66 to 0.71 when adding BSI to a model including clinical stage, Gleason score and PSA. The 5-year probability of survival was 55% for patients without metastases, 42% for patients with BSI < 1, 31% for patients with BSI = 1 to 5, and 0% for patients with BSI > 5.


BSI can be used as a complement to PSA to risk-stratify high-risk prostate cancer patients at the time of diagnosis. This imaging biomarker, reflecting the extent of metastatic disease, can be of value both in clinical trials and in patient management when deciding on treatment.

Image analysis; Radionuclide imaging; Bone metastases; Prostate cancer