PROGNOSTIC FACTORS OF ADVANCED PROSTATIC-CARCINOMA

Eighty-two patients with advanced prostatic carcinoma were treated wit h a long-acting luteinizing hormone releasing hormone (LHRH) agonist ( Zoladex(R) depot, Zeneca Pharmaceuticals, England). The outcome of the treatment was monitored on the basis of the following prognostic fact ors: local stage, number of bone metastases, histological differentiat ion grade and prostate-specific acid phosphatase (PAP), alkaline phosp hatase (AF) and testosterone levels. The patients were followed-up unt il disease progression or until death. The mean weight of the prostate decreased from 48.1 g to 17.4 g (IJ < 0.00001) during the first year of treatment. Statistically there was a significant difference in rega rd to appearance of progression between different clinical stages (P < 0.00001). The prognosis was poorest in patients with more than 10 met astases at the primary stage. If the PAP level was initially high (ove r 20 mu g/L), the prognosis was very poor. Statistically there was a s ignificant difference between the high PAP level and the slightly elev ated or normal FAP (P < 0.02 and P < 0.005, respectively). Alkaline ph osphatase (AF) appeared to be a good prognostic factor. The prognosis was particularly poor, if the AF level exceeded 1000 U/L (P < 0.00001 and P < 0.05, compared with normal AF and slightly elevated AP level, respectively). Surprisingly, a high pre-treatment testosterone level w orsened the prognosis during the LHRH agonist treatment (P < 0.01, com pared to patients with normal testosterone level). This is a new findi ng and controversial to the findings reported before.