Pattern of progression and survival in hormonally treated metastatic prostate cancer

Background: Patients with prostate cancer generally respond to androgen abl ation therapy, bur progression to androgen-independence is frequently obser ved. To further evaluate disease progression, the pattern of progression an d survival in hormonally treated metastatic prostate cancer was examined. Methods: One hundred and ninety-three patients with untreated metastatic pr ostate cancer (TxNxM1) who received endocrine therapy between 1986 and 1995 were included in the present study. The pattern of progression was evaluat ed in these patients. Results: One hundred and eighteen of the 193 patients (61.1%) had disease p rogression: 33 had local progression, 73 had distant progression and 12 had distant with local progression. Patients with only local progression had a longer interval to disease progression and longer survival than those with distant progression. The interval from disease progression to death in pat ients with local progression was longer than in those with distant progress ion. The patients whose prostate-specific antigen (PSA) had not been normal ized 3 months after the start of endocrine therapy had a tendency to progre ssion either into the prostate or into distant sires. Patients with extent of disease (EOD) scores of 3 and 4 pl ogress, especially to distant sites, after endocrine treatment. Conclusions: Ln untreated metastatic prostate cancer, patients with a poor response of PSA levels and patients with a high volume of bone metastasis ( i.e. EOD 3, 4) were in the high-risk group for progression, especially to d istant sires. Progression into distant sites was a poor prognostic factor f or patients with recurrence to endocrine therapy.