Distribution of Bony Metastases in Prostatic Carcinoma

Cumming, J. A.; Hacking, Nigel; Fairhurst, Janice; Ackery, D. M.; Jenkins, J. D.

doi:10.1111/j.1464-410x.1990.tb14964.x

Cited by 46 publications

(16 citation statements)

References 3 publications

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“…23 Another study reported dedifferentiation in 68% of tumors not treated with hormones between 2 subsequent TURP procedures with a mean interval of 2.4 years. 24 Wheeler et al 25 analyzed 49 patients who were initially treated with radiotherapy. After local recurrence of prostate cancer, a statistically significant shift to higher grades was seen.…”

Section: Discussionmentioning

confidence: 99%

Gleason score, age and screening: Modeling dedifferentiation in prostate cancer

Draisma

Postma

Schröder

et al. 2006

Intl Journal of Cancer

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Tumor differentiation as measured by the Gleason score is highly predictive of the course of prostatic cancer after diagnosis. Since the introduction of the prostate-specific antigen (PSA) test tumors are diagnosed with a favorable tumor stage and differentiation grade. Does screening with PSA just detect more tumors with favorable characteristics or is dedifferentiation actually being prevented by early detection and consequent treatment? The latter option implies that tumors dedifferentiate in the preclinical screen-detectable phase. To model the natural history of prostate cancer, we analyzed the age-specific distribution of clinical stage and Gleason score of 2,204 tumors diagnosed in the ERSPC-Rotterdam trial. We fitted 2 MISCAN simulation models to the observed data: Model I where tumors dedifferentiate before becoming screen-detectable and Model II where dedifferentiation occurs during the screen-detectable preclinical phase. The hypothesis of dedifferentiation during the screen-detectable phase was tested by a goodness of fit test of both models. In ERSPC-Rotterdam, we observed a significantly more favorable distribution of Gleason scores in screen-detected cancers compared to cancers found in the control arm, and in cancers detected in the second round compared to cancers detected in the first round of screening. Also, a significant association between Gleason score and age at diagnosis was found, most notably in cancers detected in the first round of screening. These findings were reproduced by Model II and less so by Model I, with a significant difference in goodness of fit between the 2 models (p < 0.001).This study provides epidemiological evidence of dedifferentiation as a major mechanism of progression in prostate cancer. Tumors dedifferentiate during the screen-detectable phase and consequently screening with PSA and early treatment can possibly prevent dedifferentiation. ' 2006 Wiley-Liss, Inc.Key words: prostatic neoplasms; Gleason score; screening; computer simulation; aging In the western world the incidence of prostate cancer is increasing because of the general availability of serum tests for prostate specific antigen (PSA) and aging of the population.1 Early detection by PSA testing and curative treatment of prostate cancer may result in a decrease in mortality from prostate cancer, 2 but definite evidence for this effect is not yet given. Nevertheless, trial results show that TNM stage and Gleason score of screen-detected tumors compare favorably to those of clinically diagnosed tumors in the control arms of the trials 3,4 ; in particular Gleason score is predictive for treatment success and survival. 5 It is tempting to deduce that early detection by screening and treatment could prevent tumor growth and dedifferentiation. However, the favorable characteristics of screen-detected cancers might be due to length bias sampling: tumors with favorable characteristics probably grow more slowly and have more chance of being detected; moreover, these tumors might never give rise to clinical sym...

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Section: Discussionmentioning

confidence: 99%

Gleason score, age and screening: Modeling dedifferentiation in prostate cancer

Draisma

Postma

Schröder

et al. 2006

Intl Journal of Cancer

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“…We found that the lumbar part of the spine was the area most frequently affected by metastases; next were the thoracic and cervical portions. The level of the vertebral column involved by the metastatic process is not primarily related to the amount of bone [5]. Additional venous pathways (Batson veins) for hematogenous metastases may also contribute to the high frequency of lumbar metastases [6,7].…”

Section: Discussionmentioning

confidence: 99%

Do metastases in vertebrae begin in the body or the pedicles? Imaging study in 45 patients.

Algra¹,

Heimans²,

Valk³

et al. 1992

American Journal of Roentgenology

160

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To establish the initial location of metastases within vertebrae and to determine the association between pedicle destruction and involvement of other parts of the vertebra by metastases, we performed a retrospective analysis of CT and plain film findings in patients in whom spinal metastases were identified for the first time.The location of destruction seen on CT was compared with the location of destruction seen on plain films. Special attention was paid to the location of destruction seen on CT in patients in whom destruction of a pedicle was seen on plain films.We tested the hypothesis that the observed location of vertebral destruction followed the sites of entry of the vertebral vessels. Materials and MethodsDuring the years i 987-i 989, 20i patients in our hospital were examined radiologically for skeletal metastases.From this group, we selected 86 patients in whom symptoms and/or signs of vertebral metastases were identified for the first time, and in whom both CT scans and plain films of the spine were obtained within a period of i week (maximum interval between both examinations, 7 days; average, 2.i days). We excluded from evaluation 4i Downloaded from www.ajronline.org by 54.245.13.81 on 05/11/18 from IP address 54.245.13.81.

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“…However, in almost a quarter of the cases, oral metastasis was found to be the first indication of an occult malignancy at a distant site [9]. CTC may bypass the filtration of the lungs through the valveless vertebral venous plexus; increased intrathoracic pressure can direct blood flow into this system from the caval and azygous venous system accounting for the increased distribution of axial skeleton and head and neck metastasis [55,56]. In addition, because of their unusual plasticity, CTC may pass through the arteriovenous shunts in the lungs, seeding in distal organs.…”

Section: Metastasis To the Jaws And Oral Cavitymentioning

confidence: 99%

Metastatic Tumors to the Jaws and Mouth

Hirshberg

Berger

Allon

et al. 2014

Head and Neck Pathol

155

171

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Metastatic dissemination to the oral cavity is rare and is usually the evidence of a wide spread disease with an average survival rate of 7 months. In almost a quarter of the cases, oral metastasis was found to be the first indication of an occult malignancy at a distant site. Metastatic lesions can be found anywhere in the oral cavity, however, the jawbones with the molar area is the most frequently involved site. In the oral soft tissues, the gingiva is the most common site, suggesting the possible role of inflammation in the attraction of metastatic deposits. The most common primary malignancies presenting oral metastases were the lung, kidney, liver, and prostate for men, and breast, female genital organs, kidney, and colorectum for women. Most patients with jawbone metastasis complain of swelling, pain, and paresthesia. An exophytic lesion is the most common clinical presentation of metastatic lesions in the oral soft tissues. Early lesions, mainly those located in the gingiva, may resemble a hyperplastic or reactive lesion. Once a lesion is recognized as metastasis, the primary tumor site should be identified following clinical, radiological and histopathological investigations. If standardized diagnostic workup fails to detect the site of origin, then the term carcinoma of unknown primary is applied. Personalized medicine tools such as tissue-oforigin assays should be applied, either by immunohistochemical testing or by molecular-profiling methods as these may lead to a more favorable outcome.

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Distribution of Bony Metastases in Prostatic Carcinoma

Cited by 46 publications

References 3 publications

Gleason score, age and screening: Modeling dedifferentiation in prostate cancer

Gleason score, age and screening: Modeling dedifferentiation in prostate cancer

Do metastases in vertebrae begin in the body or the pedicles? Imaging study in 45 patients.

Metastatic Tumors to the Jaws and Mouth

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