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Several guidelines have indicated that in patients with well-differentiated or moderately well-differentiated prostate cancer (PCa), a staging bone scan may be omitted.
A combination of CT, MRI and bone scan may be required, depending on the conventional X-ray presentation of the lesion.
The bone scan may be used as part of an evaluation protocol for a new cancer therapy.
Therefore, we suggest that bone scan may be unnecessary for esophageal squamous cell carcinoma restricted to mucosa.
Screening for primary site recurrence (e.g. colonoscopy) is also clearly important and an isotope bone scan may be useful.
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Bone metastases which elicit enough osteoblastic activity to be detected on bone scanning may be beyond ablation by this method.
Bone metastases usually induce osteoblastic activity, so serial bone scans may be used to monitor response or more usually failure of response to treatment.
Serial bone scans may be used to evaluate the effect of therapy, for example anti androgen therapy in prostate cancer and anti oestrogen therapy in breast cancer.
However, bone scans may be misleading when carried out early, notably 3 days prior to the evolution of symptoms, as was observed in one of our cases [ 3, 19].
3 The usefulness of assessment methods is under ongoing evaluation; a recent European paediatric Soft tissue Sarcoma Group (EpSSG) analysis showed that otherwise low-risk patients are unlikely to have isolated bone metastasis; in future bone scans may be omitted for these patients.
A bone mineral density scan may be considered during pre-operative assessment in patients with suspected osteopenia or frank osteoporosis.
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