Herein we analyze retrospectively 95 patients with metastatic prostatic adenocarcinoma managed at Seoul National University Hospital during a 10 year period from January 1981 to December 1990. Major presentations are prostatism(57.9%), urinary
retention
and bone pain. Sixteen patients were diagnosed as B.P.H. initially and in 79 patients, hard nodules were palpable by rectal examination. In all patients, distant metastases were found by various diagnostic procedures including bone survey, bone
scan and
CT scan. Major metastatic sites were bone(63.2%), lung(15.8%), lymph node(105%) and liver(8.4%). In 29 patients, multiple metastases were identified. In 79 patients, endocrine therapy was performed such as orchiectomy(50 patients), DES(19
patients),
orchiectomy plus DES(7 patients), LHRH analogue(2 patients). In 37 patients, TUR of prostate was performed to relieve the infravesical obstruction. Most of the patients The 2 year survival rate was 57.9% and 5 year survival rate was 18.9%.
Prognostic
significance of various factors such as age, weight loss, hemoglobin, serum acid and alkaline phosphatase, Gleason's sum, metastatic site and treatment regimens were evaluated by univariate analysis. Anemia weight loss, Gleason's sum, serum acid
phoshatase influenced the survival significantly(p<0.05). Serum prostate specific antigen(PSA) was determined in 30 patients. The mean PSA level was 687.3±219.1 ng/ml. After endocrine therapy PSA level was decreased 85% in lmonth and normalized
in
3
month followup. Serum PSA levels were relatively represented the clinical status of the patients.
Metastatic prostatic cancer shows variable clinical courses and prognoses. The effective management could be planned according to understanding of the biologic behaviour of the tumor.
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