Prognosis of the metastatic prostatic carcinoma and analyze the relative factors / 中华泌尿外科杂志

ABSTRACT

Objective To discuss the prognosis of the metastatic prostatic carcinoma and analyze the relative factors. Methods From 2001 to 2002, 32 cases of matastatic prostatic carcinoma were admitted to our hospital, the ages ranging from 54 to 87, with the mean age of 71 years. All the diagnosis was proved by the six cores transrectal biopsy of the prostate. The serum PSA ranged from 63 to 2000 ng/ml. Two cases had the Gleason score of 2 - 6, 19 cases had the Gleason score of 7 and 11 cases had the Gleason score of 8 - 10. Preoperative routine examinations included serum testosterone, pelvic CT or MRI scan, CXR and bone scan. Twenty-seven cases were found to have osseous metastasis, among them 8 cases combined with lymph nodes metastasis, and 5 cases with lymph nodes metastasis only. All of them were treated with gonadectomy and the blockade of the androgen receptor (with Bicalutamide 50 mg/d or Flutamide 250 mg/d). It lasted 7 - 48 months with first endocrine therapy,and mid last time 23 months. After first line endocrine therapy failure, Diethylstilbestrol and Estramustine were used in the androgen-independent stage. Thirteen cases were not effective, and second therapy had effect to 19 cases and it lasted for 3 - 15 months. Results The follow-up periods ranged from 13 to 98 months, with the mean period of 33 months. Twenty-eight cases died, 4 cases survived. The median survial period was 37 months, 1-year survival rate was 100% (32/32), 3-year survival rate was 53%(17/32) , 5-year survival rate was 19%(6/23). As to the survival period, there were negative correlaions between survival and the level of PSA (r= -0. 262, P=0. 045) and the Gl-eason score (r=- 0. 624, P=0. 001). There were positive correlations between survival and the level of testosterone (r=0. 514, P=0. 008) and the age (r=0. 311, P = 0. 032). And there was no correlation between survival and the number of the positive cores of the biopsy (r=0. 211, F = 0. 158) and the clinical stage (r=0. 211, P = 0. 352). Conclusions As to the metastatic prostatic carcinoma, there are correlations between the survival and the levels of testosterone before treatment, age, the Gl-eason score and the level of PSA. There is no relationship between the survival period of the metastatic prostatic carcinoma and the number of the positive cores of the biopsy and the clinical stage.