Metastases from cancer of the prostate. Autopsy and roentgenological findings

REVIEW OF THE RECORDS at the Pondville A Hospital for a twenty-year period (1928 through 1948) disclosed 437 cases of cancer of the prostate, the diagnosis having been made clinically or at autopsy. There were 199 who died at Pondville and autopsy findings are available in 148 cases. Of the 148, fortyfour were cases in which the prostatic carcinoma was only an incidental finding at postmortem examination, the patient having died of other causes, usually cancers elsewhere. There are thus 104 patients in whom a diagnosis of prostatic cancer had been made clinically and confirmed at autopsy. This group of 104 patients has been analyzed primarily in respect to metastatic spread as seen at postmortem, as well as to the discovery of metastasis by premortem roentgenray examination. In seven cases the neoplasm was still confined to the prostate, and in nine others the disease, although beyond the confines of the prostate, was still within the pelvis, i.e., had extended to the bladder, rectum, seminal vesicles, pelvic soft tissues, or to pelvic lymph nodes. In the other eighty-eight patients (85 per cent) there were distant metastases. The sites of the metastases in the 104 autopsied patients are listed in Table 1 (central nervous system not included). More than one third of the patients showed spread to the lungs, next in freqency to the most common site, the osseous system. As in other series the most common visceral metastases were to the liver and the lungs, with the adrenals and the pleura being next in frequency. Lymph-node involvement is indicated in Table 2. As expected, the pelvic nodes showed the greatest frequency of metastatic disease. In addition to widespread metastases, many of the cases had spread by direct extension to neighboring structures (Table 3). Growth into the bladder was about three times more common than to the rectum.