The results of clinical examination, skeletal X-ray, bone scan and
phosphatase determinations in serum were analyzed in 30 patients with metastatic
prostatic cancer prior to and during anti-androgenic treatment. Bone scan revealed skeletal
metastases in all 30 patients, whereas X-ray showed bone
metastases in only 22 patients. Radiological pseudoprogression and scintigraphic flair reaction were relatively frequent findings during the first 3-8 months of effective
hormone therapy. Later on progressive changes on X-ray and bone scan were well related to
clinical progression of the disease and indicated a poor prognosis in the individual patient. Soft tissue
metastases most often responded well to the initial
hormone treatment, but regrew only rarely during later
disease progression. Changes of the radioimmunologically determined
prostatic acid phosphatase seemed most often to indicate the presence of advanced disease and subsequent
disease progression. Second line treatment of
hormone-unresponsive
prostatic cancer is at best palliative and has not been proved to prolong the survival in most of the patients. In routine clinical practice, the need for such second line
therapy is dependent on the patient's symptoms and not on the early detection of progressive changes on X-ray, bone scan or blood tests. Therefore it seems unnecessary to perform these examinations regularly in
hormone-treated asymptomatic patients with advanced
prostatic cancer unless the patient is entered into a clinical research program.