前立腺癌骨転移診断法としての ^<99m>Tc-Sn-Polyphosphate および ^<99m>Tc-Sn-Pyrophosphate による骨 Scintigraphy の評価

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Cancer of the prostate is the most common neoplasm which is metastatic to bone. Early detection of skeletal involvement is important in predicting prognosis and selecting the proper therapy. The purpose of this study is to assess the usefulness of bone scintigraphy utilizing 99mTc-Sn-Polyphosphate (Tc-Poly P) or ^<99m>Tc-Sn-Pyrophosphate (Tc-Pyro P), a new skeletal scanning agent, for the detection of metastases from carcinoma of the prostate. Material and Method: Selected for study were 32 patients with various clinical stages of prostatic carcinoma. The age ranged from 50 to 80 years old. Histologic proof of the diseases was obtained prior to scanning. Tc-Poly P or Tc-Pyro P was prepared in the usual manner (adding 4-6 ml of ^<99m>TC pertechnetate solution to the kit). Each patient was given 5 to 10mCi of it intravenously. From 2 to 5 hours after injection, scintigraphy was performed with a scintillation camera (Nuclear Chicago, Pho/Gamma HP) or a scintillation scanner (Aloka, JSS-104 or Shimazu, SCC-130W). An x-ray bone survey of the whole body was done and serum acid phosphatase and serum alkaline phosphatase were determined. All of the scintigrams and radiographs were reviewed by the authors. They were judged to be abnormal (positive) or normal (negative) depending on presence or absence of increased uptake of isotopes or bone metastases. Result : Eighteen patients (56%) had radiographic evidence of bone metastases with all of the lesions being osteoplastic in type. In each case the scintigrams showed increased concentration of Tc-Poly P or Tc-Pyro P in the corresponding areas. The extent of tumor involvement as delineated on the scinti-gram was generally the same as or greater than that shown on the radiograph. Seventeen patients (53%) had abnormally elevated serum acid phosphatase and fifteen patients (47%) had abnormally elevated alkaline phosphatase. Twenty patients had abnormal scintigram. Of the patients with abnormal scintigram, eighteen (90%) had radiographic evidence of bone metastases. Thirteen patients (65%) had unusually high serum alkaline phosphatase level. Unusually high serum acid phosphatase level was slightly less frequent (12 patients, 60%). Twelve patients had normal Tc-Poly P or Tc-Pyro P scintigram. None of them had radiographic evidence of bone metastascs and abnormally elevated serum alkaline phosphatase. Four patients (33%) in this group had elevated serum acid phosphatase. Histological findings of the abnormal areas noted on scintigrams were studied in seven cases. Metastatic carcinomas were proved in two of five cases of biopsy and in two cases of autopsy. Regions with abmormal scintigrams and with normal x-rays were ribs (7 cases), sterns (5 cases), skulls (3 cases), cervical and thoracic vertebrae, coccyx and femur (each 1 case) . Conclusion: In this study, we have investigated the use of Tc-Poly P or Tc-Pyro P bone scintigraphy in an attempt to find a more accurate method for the early detection of osseous metastases from prostatic carcmoma. The results of our study suggest that Tc-Poly P or Tc- Pyro P bone scintigraphy is more sensitive than skeletal radiography in the detection of metastases from carcinoma of the prostate. We feel that Tc-Poly P or Tc-Pyro P bone scintigraphy is a more valuable diagnostic tool than x-ray bone survey, serum acid phosphatase and serum alkaline phosphatase in managing patients with prostatic carcinoma. However, further investigation is necessary before its significance can be fully evaluated.
社団法人日本泌尿器科学会の論文

前立腺癌骨転移診断法としての ^<99m>Tc-Sn-Polyphosphate および ^<99m>Tc-Sn-Pyrophosphate による骨 Scintigraphy の評価

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