Practice patterns and outcomes of equivocal bone scans for patients with castration-resistant prostate cancer: Results from SEARCH

Brian T. Hanyok, Mary M. Everist, Lauren E. Howard, Amanda M. De Hoedt, William J. Aronson, Matthew R. Cooperberg, Christopher J. Kane, Christopher L. Amling, Martha K. Terris, Stephen J. Freedland

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective: To review follow-up imaging after equivocal bone scans in men with castration resistant prostate cancer (CRPC) and examine the characteristics of equivocal bone scans that are associated with positive follow-up imaging. Methods: We identified 639 men from five Veterans Affairs Hospitals with a technetium-99m bone scan after CRPC diagnosis, of whom 99 (15%) had equivocal scans. Men with equivocal scans were segregated into “high-risk” and “low-risk” subcategories based upon wording in the bone scan report. All follow-up imaging (bone scans, computed tomography [CT], magnetic resonance imaging [MRI], and X-rays) in the 3 months after the equivocal scan were reviewed. Variables were compared between patients with a positive vs. negative follow-up imaging after an equivocal bone scan. Results: Of 99 men with an equivocal bone scan, 43 (43%) received at least one follow-up imaging test, including 32/82 (39%) with low-risk scans and 11/17 (65%) with high-risk scans (p = 0.052). Of follow-up tests, 67% were negative, 14% were equivocal, and 19% were positive. Among those who underwent follow-up imaging, 3/32 (9%) low-risk men had metastases vs. 5/11 (45%) high-risk men (p = 0.015). Conclusion: While 19% of all men who received follow-up imaging had positive follow-up imaging, only 9% of those with a low-risk equivocal bone scan had metastases versus 45% of those with high-risk. These preliminary findings, if confirmed in larger studies, suggest follow-up imaging tests for low-risk equivocal scans can be delayed while high-risk equivocal scans should receive follow-up imaging.

Original languageEnglish (US)
Pages (from-to)242-248
Number of pages7
JournalAsian Journal of Urology
Issue number3
StatePublished - Jul 2019
Externally publishedYes


  • Bone scan
  • Castration-resistant prostate cancer
  • Equivocal test result
  • Follow-up imaging
  • Neoplasm metastasis
  • Radiology report

ASJC Scopus subject areas

  • Urology


Dive into the research topics of 'Practice patterns and outcomes of equivocal bone scans for patients with castration-resistant prostate cancer: Results from SEARCH'. Together they form a unique fingerprint.

Cite this