Studies reported so far indicate that changes in BSI induced by chemotherapy and immunomodulator treatment correlate with overall survival in patients with metastatic castration-resistant prostate cancer. In those studies, BSI was assessed just before the start of treatment and about 3 months after the start of treatment.
Prof. Anders Bjartell, MD, PhD
Department of Urology at Skåne University Hospital, Malmö, Sweden
We should be more active than before, since we have new treatment options today. We need to select the most suitable therapy for each individual and evaluate carefully the response. The possibility to assess three disease markers - PSA, ALP and BSI - regularly at about 3-month intervals should be considered. PSA has shown less reliable in some mCRPC-patients. Alkaline phosphatase (ALP) is probably more informative than we used to think. Bone Scan Index (BSI) is a new tool, but based on a well-established methodology for monitoring skeletal tumor burden before and during treatment.
Prof. Anders Bjartell, MD, PhD
Department of Urology at Skåne University Hospital, Malmö, Sweden
Bone scintigraphy is standardized on a global level, inexpensive and quantifiable. This modality is more objective and intelligible than MRI. The rapid development of MRI-based methods is impressive, but we still suffer from the lack of standardization of equipment, image acquisition protocols and reading. Quantification of bone metastases using MRI is not yet part of clinical routine.
Prof. Anders Bjartell, MD, PhD
Department of Urology at Skåne University Hospital, Malmö, Sweden
A flare phenomenon in bone scans usually indicates a favorable response to treatment, but it could be misinterpreted as progression of disease due to a transient increase in activity of previously known metastases. It is caused by an intense osteoblastic response reflecting healing. Observation of the flare phenomenon is more common in bone scans obtained after less than 3 months of therapy and less common after approximately 6 months.
I would therefore recommend, as indicated by the PCWG-2 guidelines, to obtain bone scans before treatment and after 3 months of treatment. In case of increasing BSI, a confirmatory bone scan 6 weeks later should help to exclude the presence of flare.
Mariana Reza, MD
Department of Clinical Physiology, Clinical Sciences, Malmö, Lund University, Sweden
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