A HETEROGENEOUS PATTERN OF PROGRESSION IN ENDOCRINE-TREATED PATIENTS WITH PROSTATE-CANCER

Prostatic carcinoma often shows different behavior in the primary site than in the metastases after endocrine treatment. The pattern of dise ase progression was evaluated in prostate cancer patients. Two hundred and sixty consecutive patients were observed following the initiation of endocrine treatment (11 patients with stage T1 disease, 42 with st age T2 70 with stage T3, 11 with N+MO and 126 with stage M1 disease). Of the 117 patients whose disease progressed, 100 could be evaluated i n terms of the pattern of disease progression. Twenty-two (64.7%) of t he 34 patients with stage T1-3N0M0 showed a pattern of local progressi on. On the other hand, 56 (84.8%) of the 66 patients with stage N+ or M1 experienced a pattern of distant progression. Patients with only di stant progression numbered 36 cases and patients with local progressio n and distant progression numbered 20 cases. Most of the distant progr essions appeared in bone site. Local progression was observed in only 30 (45.5%) patients with stage N+ or M1 disease. In patients with loca lized disease (T1-3N0M0), both the interval to disease progression and the time to cancer death from the start of disease progression were s ignificantly longer than those of patients with stage N+ or M1. Howeve r, once bone metastasis occurred, the disease tended to progress rapid ly. There was no significant difference between the interval to cancer death after the appearance of bone metastasis in patients with initia lly localized stages (T1-3N0M0) and the time to cancer death after dis ease progression in patients with metastatic disease (N+ or Mi). The s tudy shows a heterogenous behavior of the prostatic tumor after endocr ine treatment. This suggests that metastases and primary tumor have di fferent clonal compositions. The study also supports the idea that the re is a preferential environment for the growth of prostatic carcinoma cells in bone sites.