Fabozzi S J, Schellhammer P F, el-Mahdi A M
Department of Urology, Eastern Virginia Medical School, Norfolk.
Cancer. 1995 Jun 1;75(11):2706-9. doi: 10.1002/1097-0142(19950601)75:11<2706::aid-cncr2820751111>3.0.co;2-y.
Lung metastases are rarely a significant factor in the management of prostate cancer. The usual pattern of spread is via lymphatic pathways, with pulmonary metastases virtually always occurring with osseous metastases. Previous reports suggest that androgen deprivation often fails to produce significant improvement in patients with pulmonary metastases; however, in the authors' experience, it has been successful in achieving objective responses.
A retrospective review of a large prostate cancer data base was performed to identify patients with adenocarcinoma of the prostate and radiographic evidence of pulmonary metastases. A unique case of isolated pulmonary metastases with exsanguinating hemoptysis is described to illustrate the dramatic response to androgen deprivation.
Of 1290 patients with biopsy-proven adenocarcinoma of the prostate, in 47 (3.6%) patients radiologic evidence of pulmonary metastases was observed. Twenty-six (2.0%) patients demonstrated pulmonary metastases at the time of initial detection of metastatic disease. The radiographic appearance of pulmonary metastases was consistent with lymphangitic spread in the majority of patients. Of patients who received no hormonal therapy before the development of pulmonary metastases, 76.5% showed improvement in the appearance of their pulmonary lesions with androgen deprivation. As expected, survival was longer for those patients presenting with hormone-naive disease and pulmonary metastases than for patients with hormone-refractory disease and pulmonary metastases. The difference in survival, however, was not statistically significant.
Pulmonary metastases are not encountered commonly in patients with prostate cancer. Androgen deprivation remains the most effective treatment and, among hormone-naive patients, objective response is common. The prognosis for patients with hormone-naive disease and pulmonary metastases is not necessarily worse than for patients with metastatic disease at other sites.
肺转移在前列腺癌的治疗中很少是一个重要因素。常见的转移途径是通过淋巴系统，肺转移几乎总是与骨转移同时发生。既往报道提示，雄激素剥夺疗法往往不能使肺转移患者获得显著改善；然而，根据作者的经验，该疗法已成功实现了客观缓解。
对一个大型前列腺癌数据库进行回顾性分析，以确定患有前列腺腺癌且有肺转移影像学证据的患者。描述了一例孤立性肺转移伴致命性咯血的独特病例，以说明对雄激素剥夺疗法的显著反应。
在1290例经活检证实为前列腺腺癌的患者中，47例（3.6%）有肺转移的影像学证据。26例（2.0%）患者在初次发现转移疾病时即有肺转移。大多数患者肺转移的影像学表现符合淋巴管播散。在发生肺转移之前未接受激素治疗的患者中，76.5%的患者在接受雄激素剥夺治疗后肺部病变外观有所改善。正如预期的那样，初治疾病伴肺转移的患者比激素难治性疾病伴肺转移的患者生存期更长。然而，生存期的差异无统计学意义。
前列腺癌患者中肺转移并不常见。雄激素剥夺仍然是最有效的治疗方法，在初治患者中，客观缓解很常见。初治疾病伴肺转移患者的预后不一定比其他部位转移疾病患者更差。
