Carcinoma of the prostate with soft tissue or non-regional lymphatic metastases at the time of diagnosis: a review of 47 cases.

The clinical course of 47 patients with carcinoma of the prostate who at the time of initial presentation had metastases to soft tissue or non-regional lymph nodes was retrospectively reviewed. The response rate to primary hormonal treatment (orchiectomy or oestrogens) and the duration of response were similar to those of 47 other patients presenting with skeletal metastases only. The survival of the patients in the study group was not statistically different from that of patients with skeletal metastases only. The results suggest that patients presenting initially with metastases to non-regional lymph nodes or soft tissue should be treated by the same therapeutic methods as for disseminated prostatic cancer in general (oestrogens or orchiectomy). Slight or no urinary symptoms at the time of initial presentation in spite of a locally advanced tumour was a common finding; 20% of the patients had normal serum prostatic acid phosphatase despite the presence of disseminated disease. Lymph node enlargement in the left supraclavicular fossa was the most common site of non-regional lymphatic spread. Elderly males with metastatic carcinoma in this region should be investigated for the possibility of prostatic cancer.