The course of metastatic disease originating from carcinoma of the prostate
The purpose of this work was to study the time sequence and the patterns of the multistep spread of metastases. Fifty-one patients with stage D carcinoma of the prostate, previously treated for their primary tumor by surgery or radiotherapy combined with hormonal manipulation and for metastases by hormones and chemotherapy, were included in the study. The metastatic dissemination, characterized primarily by the appearance of bone metastases, could follow two distinct patterns: The first, characterized by sequential appearance of osteoblastic metastases, followed by the development of osteolytic bone lesions, and the second pattern, characterized by the simultaneous appearance of osteoblastic and osteolytic bone lesions.
In cases with solely osteoblastic bone metastases, the lesions are hormone sensitive and long-lasting remissions could be obtained. The development of osteolytic bone lesions is usually accompanied by the recurrence of the primary tumor and appearance of metastases in other sites, such as the lymph nodes and lungs. Bone metastases became resistant to hormonal manipulation and with chemotherapy short remissions were obtained. The course of the terminal period is faster, with shorter survival times. The determination of serum acid and alkaline phosphatase levels seems to reflect the course of the disease during the initial period of the disease only, i.e. when bone metastases are sensitive to hormonal treatment.
KeywordsPrimary Tumor Alkaline Phosphatase Bone Metastasis Hormonal Treatment Time Sequence
Unable to display preview. Download preview PDF.
- American Joint Committee for Cancer Staging and End Results Reporting (AJCCS):Manual for Staging of Cancer, 1978, AJCCS, Chicago, 1977.Google Scholar
- Brawn, P. N., 1983, The dedifferentiation of prostate carcinoma.Cancer,52, 246–251.Google Scholar
- Byar, D. P., 1973, The Veterans Administration Cooperative Urological Research Group's studies of cancer of the prostate.Cancer,32, 1126–1130.Google Scholar
- Chu, T. M., Wang, M. C., Scott, W. W., Gibbons, R. P., Johnston, D. E., Schmidt, J. D., Leoning, S. A., Prout, G. R., andMurphy, G. P., 1978, Immunochemical detection of serum prostatic acid phosphatase methodology and clinical evaluation.Investigative Urology,15, 319–323.Google Scholar
- Corriere, J. N., Cornog, J. L., andMurphy, J. J., 1970, Prognosis in patients with carcinoma of the prostate.Cancer,25, 911–918.Google Scholar
- Franks, L. M., 1956, The spread of prostatic cancer,The Journal of Pathology and Bacteriology,72, 603–611.Google Scholar
- Franks, L. M., 1953, The spread of prostatic carcinoma to the bones.The Journal of Pathology and Bacteriology,66, 91–93.Google Scholar
- Gleason, D. F., Mellinger, G. T., andThe Veterans Administration Cooperative Urological Research Group, 1974, Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging.The Journal of Urology,111, 58–64.Google Scholar
- Gilbert, H. A., andKagan, A. R., 1976, Metastases, incidence, detection, and evaluation without histological confirmation.Fundamental Aspects of Metastasis, edited by L. Weiss (Amsterdam, Oxford: North Holland), pp. 385–405.Google Scholar
- Paulson, D. F., Perez, C. A., andAnderson, T., 1982, Genitourinary malignancies, prostatic cancer.Cancer, Principles and Practice of Oncology, edited by V. T. DeVita, S. Hellman and S. A. Rosenberg (Philadelphia, Toronto: Lippincott), pp. 753–769.Google Scholar
- Poste, G., 1981, Cellular heterogeneity in malignant neoplasms and regulation of the metastatic phenotype.VIth Meeting of the European Association for Cancer Research, Abstract, p. 10.Google Scholar
- Rous, S. N., andMallouh, C., 1972, Prostatic carcinoma: the relationship between histologic grade and incidence of early metastases.The Journal of Urology,108, 905–907.Google Scholar
- UICCTechnical Report Series, Volume 51, 1982,TNM Classification of Malignant Tumors. A Brochure of Checklists (Geneva: UICC), p. 20.Google Scholar
- Viadana, E., Bross, I. D. J., andPickren, J. W., 1975, The metastatic spread of kidney and prostate cancers in man.Neoplasma,23, 323–332.Google Scholar
- Weber, P., Oeser, H., Taenzer, V., Rost, H., andKelami, A., 1974, Die extraossäre Metastasierung des Prostatakarzinoms.Deutsche Medizinische Wochenschrift,99, 2148–2150.Google Scholar
- Willis, R. A., 1973,The Spread of Tumors in the Human Body (London: Butterworths), pp. 229–247.Google Scholar