Transrectal ultrasonometry of the prostate: the prognostic relevance of volume changes under endocrine management

Summary

Since 1980, a total of 55 patients with previously untreated prostatic carcinoma have been managed by castration and were followed regularly by means of transrectal ultrasonometry of the prostate. During the period of the study, distant metastases occurred in 20 patients; 10 showed progression after less than 1 year and 10 after more than 1 year. All patients showed a decrease of prostatic volume following castration. In the group of 10 patients who progressed within 1 year after castration, the initial volume reduction of the prostate was significantly smaller than in the rest of the patients. In patients whose prostatic volume decreased to at least 50% of the pretreatment volume after 3 months, none developed distant progression within 1 year. Of those patients whose prostatic volume did not decrease to at least 70% of the pretreatment volume after 3 months, 78% developed distant progression before or after 1 year. There was no significant difference in the volume decrease observed in patients who showed progression later than 1 year after initiation of treatment as compared to those patients who did not show progression at all. This prognostic information was compared to the impact of other commonly used prognostic factors, such as T-category, N- and M-status and grading. None of these factors reproduced the predictive value of the volume changes of the primary tumor. It therefore seems that transrectal ultrasonometry of the primary tumor has a place in monitoring the effects of endocrine management. The prediction of progression in 78% of the patients with prostatic volume >70% may be of limited clinical value now, but will be of greater importance as soon as effective treatment for hormone-unresponsive prostatic carcinoma becomes available.