THE VALUE OF PRETREATMENT CLINICAL AND BIOCHEMICAL PARAMETERS IN PATIENTS WITH NEWLY-DIAGNOSED UNTREATED PROSTATE CARCINOMA AND NO INDICATIONS FOR BONE METASTASES ON THE BONE SCINTIGRAM

Between 10% and 25% of patients with newly diagnosed prostate cancer w ithout bone metastases at the time of diagnosis will develop metastase s during follow-up. To determine the value of clinical and biochemical parameters for assessment of prognosis at the time of diagnosis, a re trospective study was performed in 124 consecutive patients with newly diagnosed prostate cancer without bone metastases. The mean follow-up was 41 months, during which time 36 patients died and 15 patients dev eloped metastases. Bone scans were classified from 0 (=normal) through 2 (=abnormal, but not typical for metastases) and were correlated wit h age, alkaline phosphatase (AP), prostate-specific antigen (PSA), tum our grade, T-stage and N-stage. In patients with a class 2 scan, addit ional roentgenograms and follow-up were used to exclude metastases at initial stage. All parameters, including therapy, were finally correla ted with the development of metastases and survival. For survival 38 p atients with proven metastases were used as controls. For all paramete rs tested, no statistically significant differences were found between the three bone scan classifications. The interval between diagnosis a nd the development of metastases ranged from 12 to 72 months. For the risk of development of metastases only PSA was found to be a significa nt correlate (P=0.0075), However, when tumour stages were clustered in limited disease (T0-2) and extensive disease (T3-4), the incidence of metastases was significantly higher in patients with extensive diseas e than in those with limited disease (P=0.0021). Finally, age, PSA and Anderson classification were found to be significant correlates of su rvival, but in stepwise analysis PSA was selected as the most prognost ic variable (P<0.0001). In contrast with a typical pattern of metastas es on bone scintigraphy, an abnormal scan (class 1 and 2) at the time of diagnosis is not a poor prognostic parameter of the risk of death. In conclusion, in patients with prostate cancer without bone metastase s at the time of diagnosis, pretreatment PSA and tumour stage can be u sed for the assessment of risk of development of metastases during fol low-up and survival. For this purpose, tumour stage should be clustere d in limited and extensive disease.