Review of Clinical Manifestations of Biochemically-advanced Prostate Cancer Cases

Objective To review the pattern of initial clinical manifestation of patients who present with biochemically-advanced prostate carcinoma. Methods A review of 39 prostate cancer patients with initial prostate specific antigen (PSA) levels of more than 400 ng/mL (study group) and 40 patients whose initial PSA levels were between 20 and 399 ng/mL (control group) was done. Results The epidemiological profile and median Gleason score were similar in both groups. In the study and control groups, the median initial PSA levels were 1,000 ng/mL (range, 400-20,000 ng/mL) and 83 ng/mL (range, 21.8-337 ng/mL) respectively. Patients in the study group had statistically significantly higher incidences of bone pain, weight loss, loss of appetite, weakness in the lower limbs, and findings of abnormal prostate on digital rectal examination than patients in the control group. Significantly higher morbidity, including spinal cord compression, systemic lymphadenopathy, chronic urinary retention, elevated serum creatinine levels, anaemia and bone metastases, were also seen in the study group compared to the control group. Similar proportions of patients in the two groups developed hormone escape after treatment (50% in the study group, 45% in the control group). The cancer-specific mortality rate was 39.5% in the study group and 17.5% in the control group. Conclusion There is a high incidence of excess morbidity in patients who present with biochemically-advanced prostate carcinoma.