{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:56:31Z","timestamp":1786114591213,"version":"build-2736575974"},"reference-count":28,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007428","name":"Naito Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007428","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016925","name":"Takeda Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the use of bone scan index (BSI)\/initial prostate\u2010specific antigen (iPSA) ratio, a novel biomarker that can reveal discordance between PSA level and bone metastasis volume, and to investigate its prognostic significance in patients with hormone\u2010sensitive prostate cancer (PCa) and bone metastasis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>Clinical data were collected from 526 patients with bone metastatic PCa between 2009 and 2025 from multiple centres. Cancer\u2010specific survival and overall survival (OS) were evaluated as clinical outcomes, and prognostic factors were analysed using multivariate Cox proportional hazard modelling and Kaplan\u2013Meier methods. Survival tree analysis was performed to identify the optimal cut\u2010off for stratifying prognosis. Propensity\u2010score matching (PSM) was used to equalise patient baseline characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median age at diagnosis, initial PSA level and BSI were 75\u2009years, 229.8\u2009ng\/mL and 1.6%, respectively. Survival tree analysis identified 0.02 as the optimal cut\u2010off for BSI\/iPSA ratio. Kaplan\u2013Meier analysis showed that a high BSI\/iPSA ratio (\u22650.02) was associated with shorter OS compared with a low BSI\/iPSA ratio (&lt;0.02; hazard ratio [HR]\u20091.91;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.0001). Statistical significance remained after PSM analysis (HR\u20091.63;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0303). Multivariate analysis showed that a high BSI\/iPSA ratio was an independent prognostic factor for OS (HR\u20092.03;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0046). Notably, patients with a high BSI\/iPSA ratio were less likely to have a PSA progression\u2010only pattern of recurrence (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0122).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Discordance between PSA level and bone metastatic volume indicated the presence of non\u2010PSA\u2010producing tumour and was correlated with increased risk of death. Our findings will help facilitate a personalised therapeutic approach for patients with metastatic prostate cancer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70081","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T14:14:29Z","timestamp":1763043269000},"page":"368-375","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Discordance between\n                    <scp>PSA<\/scp>\n                    level and bone metastatic volume is associated with unfavourable prognosis"],"prefix":"10.1111","volume":"137","author":[{"given":"Tomoki","family":"Shirafuji","sequence":"first","affiliation":[{"name":"Department of Urology Chiba University Graduate School of Medicine  Chiba 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Medical and Pharmaceutical University  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ko","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Urology Osaka Medical and Pharmaceutical University  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Urology Kimitsu Chuo Byoin  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Arai","sequence":"additional","affiliation":[{"name":"Department of Urology Chiba Rosai Hospital  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6516-2519","authenticated-orcid":false,"given":"Hiroaki","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Urology Chibaken Saiseikai Narashino Hospital  Chiba 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