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Secondary Tumors of the Prostate
TIIE JOURNAL
or
Vol. 112, Octobe1 Printed
UROLOGY
Copyright© 1974 by The Williams & Wilkins Co.
SECONDARY TUMORS OF THE PROSTATE DOUGLAS E. JOHNSON, ROMAN CHALBAUD
AND
ALBERTO G. AYALA
From the Department of Surgery, Section of Urology and the Department of Pathology, The Uniuersity of System Cancer Center, M. D. Anderson Hospital and Tumor Institute, Houston, Texas
Hematogenous and metastases to the prostate are uncommon, fewer than 25 cases having ~-·~-·-·-rl to date. 1· 5 These most
the literature and report our cases. MATERIAL AND METHODS
precocious tumor results symptoms and
inflammatory confused with a primary an unsuspecting clinician. 5-s Since '"'LvuLtcu, tumors of the prostate have been described we decided to review
F1G. l. Metastatic undifferentiated carcinoma of lung (oat enlarging and destroying prostatic acinus. Notice trapped corpora
_ _ _ _ ,.
Accepted for publication April 19, 1974. 1 M. E.: Secondary tumors of the genito-uri65: 144, 1951. and a~,,u,m,,,
Primary Site Skin Lung Pancreas Stomach Penis Larynx Total
Metastatic melaCancer, 17: 1323,
1-listologic Type
No. Ca.ses
____
---
With static tasia~~es No. (Cl(,l
Malignant melanoma
1,779
9 {O.G)
Bronchogenic Ca
4,32:l 278
fl (C.'.2j ?, (O."?; 1 (;).'.;'.)
Adenoca. Adenoca.
1953.
605 cell Ca
220
1,286
l (D/•) 1 ((L 1)
18 ----------------
RESULTS
D. and P. L.: Metastatic carcinoma of the prostate silent carcinoma of the stomach. A case report. J. Okla. Med. Ass., 55: 77, 1962. 8 Dowd, ,J.B.: Carcinoma of the presenting as obstructing cancer of the prostate. Ciin. Bull., 13: 204, 1964.
The site of the
tumor lung in 5 1) pancreas, and l instar,cs each. The morphologic features of these 507
508
JOHNSON, CHALBAUD AND AYALA
FIG. 2. Metastatic squamous carcinoma. Nests of large polygonal cells are infiltrating fibromuscular stroma. Distorted prostatic duct is seen in left upper corner. Reduced from x50.
well as the relative incidence of secondary metastases according to the primary site of origin are given in the table. Patient age at which time diagnosis of secondary prostatic involvement was established ranged from 30 to 78 years, with an average of 56 years. The lesions were diagnosed on clinical findings in only 3 patients (17 per cent) and, in each of these cases, symptoms of obstructive uropathy prompted urological evaluation leading to the diagnosis. Survival time following discovery of the prostatic metastasis was 4 months in 2 cases and 18 months in the other. In the remaining 15 patients the secondary tumor was an incidental finding at necropsy in patients who had died of disseminated malignant disease. Gross features of the prostate were variable. The prostate was normal when palpated or inspected in 6 cases, nodular or irregular in 8 cases and decidedly enlarged in 4 cases. In 6 patients the lesions were microscopic, ranging from a few malignant cells in vascular channels (2 cases) to tiny nodules less than 2 mm. in diameter (4 cases). In the remaining 12 patients the lesions were well circumscribed gross nodules (10 cases) or infiltrating lesions replacing a large portion of the prostate (2 cases) (fig. 2). DISCUSSION
Secondary tumors of the prostate originating from a distant primary neoplasm are rare. Only 3 cases were diagnosed clinically in 31,927 male patients with malignant disease undergoing treatment during the period of this study, an incidence of 0.01 per cent. In addition, our finding of only 15 cases with prostatic metastases in 3,663 male patients with malignant disease undergoing ne-
cropsy (0.5 per cent) attests to the rarity of this condition. It is difficult to explain the relative infrequency of secondary tumors of the prostate, since one might expect a higher incidence in view of the complex pelvic and vertebral venous network described by Batson. 9 However, our study suggests that, in most instances, these lesions are a result of direct arterial dissemination and rarely result from retrograde venous or lymphatic transportation. The histologic features of a metastatic prostatic lesion are usually similar to those of the primary tumor but the malignant cells frequently have a more anaplastic appearance. Secondary tumors of the prostate must be considered a late manifestation of malignant disease and herald a poor prognosis and a rapid death when discovered in a clinical setting. The urological treatment in these situations usually requires only supportive care but transurethral or open prostatectomy may be indicated to relieve obstruction in selected cases. SUMMARY
Clinical and histologic findings in 18 patients with metastatic tumors to the prostate are presented. The sites of the primary tumors included the skin, lung, pancreas, stomach, penis and larynx. Although metastases to the prostate are rare and are usually diagnosed at necropsy in patients who died of disseminated malignant disease, occasionally precocious development of the metastatic lesion results in obstructive or inflammatory symptoms and may be mistaken for a primary prostatic carcmoma. 'Batson, 0. V.: The function of the vertebral veins and their role in the spread of metastases. Ann. Surg., 112: 138, 1940.
or
Vol. 112, Octobe1 Printed
UROLOGY
Copyright© 1974 by The Williams & Wilkins Co.
SECONDARY TUMORS OF THE PROSTATE DOUGLAS E. JOHNSON, ROMAN CHALBAUD
AND
ALBERTO G. AYALA
From the Department of Surgery, Section of Urology and the Department of Pathology, The Uniuersity of System Cancer Center, M. D. Anderson Hospital and Tumor Institute, Houston, Texas
Hematogenous and metastases to the prostate are uncommon, fewer than 25 cases having ~-·~-·-·-rl to date. 1· 5 These most
the literature and report our cases. MATERIAL AND METHODS
precocious tumor results symptoms and
inflammatory confused with a primary an unsuspecting clinician. 5-s Since '"'LvuLtcu, tumors of the prostate have been described we decided to review
F1G. l. Metastatic undifferentiated carcinoma of lung (oat enlarging and destroying prostatic acinus. Notice trapped corpora
_ _ _ _ ,.
Accepted for publication April 19, 1974. 1 M. E.: Secondary tumors of the genito-uri65: 144, 1951. and a~,,u,m,,,
Primary Site Skin Lung Pancreas Stomach Penis Larynx Total
Metastatic melaCancer, 17: 1323,
1-listologic Type
No. Ca.ses
____
---
With static tasia~~es No. (Cl(,l
Malignant melanoma
1,779
9 {O.G)
Bronchogenic Ca
4,32:l 278
fl (C.'.2j ?, (O."?; 1 (;).'.;'.)
Adenoca. Adenoca.
1953.
605 cell Ca
220
1,286
l (D/•) 1 ((L 1)
18 ----------------
RESULTS
D. and P. L.: Metastatic carcinoma of the prostate silent carcinoma of the stomach. A case report. J. Okla. Med. Ass., 55: 77, 1962. 8 Dowd, ,J.B.: Carcinoma of the presenting as obstructing cancer of the prostate. Ciin. Bull., 13: 204, 1964.
The site of the
tumor lung in 5 1) pancreas, and l instar,cs each. The morphologic features of these 507
508
JOHNSON, CHALBAUD AND AYALA
FIG. 2. Metastatic squamous carcinoma. Nests of large polygonal cells are infiltrating fibromuscular stroma. Distorted prostatic duct is seen in left upper corner. Reduced from x50.
well as the relative incidence of secondary metastases according to the primary site of origin are given in the table. Patient age at which time diagnosis of secondary prostatic involvement was established ranged from 30 to 78 years, with an average of 56 years. The lesions were diagnosed on clinical findings in only 3 patients (17 per cent) and, in each of these cases, symptoms of obstructive uropathy prompted urological evaluation leading to the diagnosis. Survival time following discovery of the prostatic metastasis was 4 months in 2 cases and 18 months in the other. In the remaining 15 patients the secondary tumor was an incidental finding at necropsy in patients who had died of disseminated malignant disease. Gross features of the prostate were variable. The prostate was normal when palpated or inspected in 6 cases, nodular or irregular in 8 cases and decidedly enlarged in 4 cases. In 6 patients the lesions were microscopic, ranging from a few malignant cells in vascular channels (2 cases) to tiny nodules less than 2 mm. in diameter (4 cases). In the remaining 12 patients the lesions were well circumscribed gross nodules (10 cases) or infiltrating lesions replacing a large portion of the prostate (2 cases) (fig. 2). DISCUSSION
Secondary tumors of the prostate originating from a distant primary neoplasm are rare. Only 3 cases were diagnosed clinically in 31,927 male patients with malignant disease undergoing treatment during the period of this study, an incidence of 0.01 per cent. In addition, our finding of only 15 cases with prostatic metastases in 3,663 male patients with malignant disease undergoing ne-
cropsy (0.5 per cent) attests to the rarity of this condition. It is difficult to explain the relative infrequency of secondary tumors of the prostate, since one might expect a higher incidence in view of the complex pelvic and vertebral venous network described by Batson. 9 However, our study suggests that, in most instances, these lesions are a result of direct arterial dissemination and rarely result from retrograde venous or lymphatic transportation. The histologic features of a metastatic prostatic lesion are usually similar to those of the primary tumor but the malignant cells frequently have a more anaplastic appearance. Secondary tumors of the prostate must be considered a late manifestation of malignant disease and herald a poor prognosis and a rapid death when discovered in a clinical setting. The urological treatment in these situations usually requires only supportive care but transurethral or open prostatectomy may be indicated to relieve obstruction in selected cases. SUMMARY
Clinical and histologic findings in 18 patients with metastatic tumors to the prostate are presented. The sites of the primary tumors included the skin, lung, pancreas, stomach, penis and larynx. Although metastases to the prostate are rare and are usually diagnosed at necropsy in patients who died of disseminated malignant disease, occasionally precocious development of the metastatic lesion results in obstructive or inflammatory symptoms and may be mistaken for a primary prostatic carcmoma. 'Batson, 0. V.: The function of the vertebral veins and their role in the spread of metastases. Ann. Surg., 112: 138, 1940.