Surprisingly, the literature suggests that such monitoring to identify an initial bone metastasis is not generally routine with one study reporting that even prostate cancer patients at high risk of developing bone metastases, such as those with prostate-specific antigen doubling time less than 3 months, did not routinely receive a second bone scan within one year after a first negative bone scan [17]. This evidence concerns the gene KLK3 and prostate carcinoma.