Pulmonary metastases from prostate cancer

Lung metastases are rarely a significant factor in the management of prostate cancer. The usual pattern of spread is via lymphatic pathways, with pulmonary metastases virtually always occurring with osseous metastases. Previous reports suggest that androgen deprivation often fails to produce significant improvement in patients with pulmonary metastases; however, in the authors' experience, it has been successful in achieving objective responses.

A retrospective review of a large prostate cancer data base was performed to identify patients with adenocarcinoma of the prostate and radiographic evidence of pulmonary metastases. A unique case of isolated pulmonary metastases with exsanguinating hemoptysis is described to illustrate the dramatic response to androgen deprivation.

Of 1290 patients with biopsy-proven adenocarcinoma of the prostate, in 47 (3.6%) patients radiologic evidence of pulmonary metastases was observed. Twenty-six (2.0%) patients demonstrated pulmonary metastases at the time of initial detection of metastatic disease. The radiographic appearance of pulmonary metastases was consistent with lymphangitic spread in the majority of patients. Of patients who received no hormonal therapy before the development of pulmonary metastases, 76.5% showed improvement in the appearance of their pulmonary lesions with androgen deprivation. As expected, survival was longer for those patients presenting with hormone-naive disease and pulmonary metastases than for patients with hormone-refractory disease and pulmonary metastases. The difference in survival, however, was not statistically significant.

Pulmonary metastases are not encountered commonly in patients with prostate cancer. Androgen deprivation remains the most effective treatment and, among hormone-naive patients, objective response is common. The prognosis for patients with hormone-naive disease and pulmonary metastases is not necessarily worse than for patients with metastatic disease at other sites.