Department of Urology, Singapore General Hospital, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
BMJ Open. 2020 Feb 18;10(2):e034331. doi: 10.1136/bmjopen-2019-034331.
To evaluate the incidence and management of local and systemic complications afflicting patients with de novo metastatic prostate cancer (mPCa) in Singapore.
Retrospective analysis of a large prospective Uro-oncology registry of mPCa.
This study is carried out in a tertiary hospital in Singapore.
We reviewed our institution's prospectively maintained database of 685 patients with mPCa over a 20-year period (1995-2014). Patients with non-mPCa or those progressed to metastatic disease after previous curative local treatments were excluded.
The primary outcome was to evaluate the systemic and local morbidity rates associated with mPCa. Local complication was defined as the need for palliative procedures to relieve urinary obstruction, worsening renal function or refractory haematuria, while systemic complication was related to radiographic evidence of skeletal-related pathological fractures. Secondary outcomes analysed were the management and overall survival patterns over 20 years.
237 (34.6%) patients required local palliative treatments. 88 (12.8%) patients presented with acute urinary retention, 23 patients (9.7%) required repetitive local palliative treatments. On multivariate analyses, prostate-specific antigen >100 (p=0.02) and prostate volume >50 g (p=0.03) were independent prognostic factors for significant obstruction requiring palliative procedures. 118 (17.2%) patients developed skeletal fractures, with poor Eastern Cooperative Oncology Group Performance (ECOG) status (p=0.01) and high volume bone metastasis (p<0.01) independently predictive of skeletal fractures. Altogether, 653 (95.3%) patients received androgen deprivation therapy (ADT), with the median time to castrate resistance of 21.4 months (IQR 7-27). The median overall survival was 45 months (IQR 20-63), with prostate cancer mortality of 81.4%. Improved overall survival was observed from 41.6 months (1995-1999) to 47.8 months (2010-2014) (p<0.01).
Morbidities and complications arising from mPCa are more common and debilitating than we thought, often requiring immediate palliative treatments, while many necessitate repeated interventions with progression.
评估新加坡初发转移性前列腺癌（mPCa）患者的局部和全身并发症的发生率和处理方法。
对 mPCa 的大型前瞻性泌尿肿瘤学登记处进行回顾性分析。
这项研究在新加坡的一家三级医院进行。
我们回顾了我院 20 年来（1995-2014 年）前瞻性维持的 685 例 mPCa 患者数据库。排除了非 mPCa 患者或先前接受根治性局部治疗后进展为转移性疾病的患者。
主要结果是评估与 mPCa 相关的全身和局部发病率。局部并发症定义为需要姑息性治疗以缓解尿路梗阻、肾功能恶化或难治性血尿，而全身并发症与骨骼相关的病理性骨折的放射影像学证据有关。分析的次要结果是 20 年来的管理和总体生存模式。
237（34.6%）例患者需要局部姑息性治疗。88（12.8%）例患者出现急性尿潴留，23 例（9.7%）患者需要重复局部姑息性治疗。多变量分析显示，前列腺特异性抗原>100（p=0.02）和前列腺体积>50g（p=0.03）是需要姑息性治疗的显著梗阻的独立预后因素。118（17.2%）例患者发生骨骼骨折，东部合作肿瘤学组表现状态差（p=0.01）和高体积骨转移（p<0.01）是骨骼骨折的独立预测因素。总共，653（95.3%）例患者接受雄激素剥夺治疗（ADT），去势抵抗的中位时间为 21.4 个月（IQR 7-27）。中位总生存期为 45 个月（IQR 20-63），前列腺癌死亡率为 81.4%。从 41.6 个月（1995-1999 年）到 47.8 个月（2010-2014 年），观察到总生存的改善（p<0.01）。
mPCa 引起的发病率和并发症比我们想象的更为常见和严重，通常需要立即进行姑息性治疗，而许多患者需要随着病情进展进行反复干预。
