Yield of bone scintigraphy for the detection of metastatic disease in treatment-naive prostate cancer: a systematic review and meta-analysis

•Positive bone scans with PSA≤10, 1020 were 3.5%, 6.9%, 41.8%. •Positive bone scans with Gleason score≤6, 7, ≥8 were 4.1%, 10.0%, 28.7%. •Low proportion of positive bone scans in patients with PSA≤20 and/or Gleason score ≤7. Aim To evaluate the yield of staging bone scintigraphy in patients with treatment-naive prostate cancer. Materials and methods A computerised search of the MEDLINE and EMBASE databases was performed to find relevant original literature. Studies that investigated the positivity of a staging bone scintigraphy according to prostate-specific antigen (PSA) levels and/or Gleason score in patients with treatment-naive prostate cancer were eligible for inclusion. Meta-analytic pooling was performed using the inverse variance method for calculating weights. Results Fifty-four eligible studies, which included a total sample size of 20,421 patients, were included. The pooled proportions of the positive bone scintigraphy in patients with PSA ≤10, 10 20 were 3.5% (95% confidence interval [CI]: 2.4–5%), 6.9% (95% CI: 4.5–10.3%), and 41.8% (95% CI: 36.3–47.6%). The pooled proportions of the positive bone scintigraphy examinations in patients with Gleason score ≤6, 7, and ≥8 were 4.1% (95% CI: 2–8%), 10% (95% CI: 6.1–15.8%), and 28.7% (95% CI: 21.8–36.8%). Meta-regression analysis revealed that the Gleason score was a significant factor affecting study heterogeneity in patients with PSA ≤10 (p = 0.04). Pooled proportions of positive bone scintigraphy examinations showed 3.4% in patients with a PSA of ≤10 and 3.3% in patients with 10 20 were 3.5% (95% confidence interval [CI]: 2.4–5%), 6.9% (95% CI: 4.5–10.3%), and 41.8% (95% CI: 36.3–47.6%). The pooled proportions of the positive bone scintigraphy examinations in patients with Gleason score ≤6, 7, and ≥8 were 4.1% (95% CI: 2–8%), 10% (95% CI: 6.1–15.8%), and 28.7% (95% CI: 21.8–36.8%). Meta-regression analysis revealed that the Gleason score was a significant factor affecting study heterogeneity in patients with PSA ≤10 (p = 0.04). Pooled proportions of positive bone scintigraphy examinations showed 3.4% in patients with a PSA of ≤10 and 3.3% in patients with 10