Low yield of bone scintigraphy in low-risk prostate cancer: A retrospective real-world analysis from Taiwan

Purpose: Bone scintigraphy has historically been used for prostate cancer staging; however, its value in low-risk (LR) and very low-risk (VLR) patients remains uncertain. Although international guidelines generally advise against its routine use, the practice remains common in Taiwan. Materials and methods: We reviewed men newly diagnosed with LR or VLR prostate adenocarcinoma at National Taiwan University Hospital from 2011 to 2019. All patients were treatment-naïve and classified according to National Comprehensive Cancer Network criteria. Demographic, clinical, and imaging data within 3 months of diagnosis were collected. Bone scan findings were categorized as cancer-related, urological, or nonurological, and cases with disagreement were discussed in consensus meetings. Results: A total of 248 patients (166 LR, 82 VLR) were included. The mean age was 66.7 years, and the mean prostate-specific antigen was 6.2 ng/mL. Magnetic resonance imaging was obtained in nearly all patients (96%), bone scintigraphy in 88%, and computed tomography in only 4%. None of the bone scans revealed true metastatic disease. Magnetic resonance imaging, by contrast, often disclosed incidental findings unrelated to prostate cancer. Conclusion: In this cohort, routine bone scintigraphy did not provide additional diagnostic benefit for men with LR or VLR prostate cancer. Our findings suggest that continued reliance on bone scans in Taiwan reflects local practice patterns rather than clinical necessity. Avoiding unnecessary scans could reduce patient burden and help align practice with international standards.