目的 骨轉移常發生在前列腺癌病人，引起併發症及死亡。攝護腺特異性抗(PSA)及骨骼掃描是評估及追蹤骨轉移的重要方法。我們回溯性分析前列腺癌合併骨轉移病人，包括臨床症狀、檢查數據、治療、預後及其相關性。方法 從1995年1月至2003年12月間，有284位前列腺癌病人在中國醫藥大學附設醫院住院治療。有97位病人被診斷骨轉移，臨床病例詳細查閱及紀錄。另外，我們將病人分成兩組：第一組病人是在診斷前列腺癌同時發現骨轉移：第二組病人是骨轉移發生在治療中的前列腺癌。結果 前列腺癌的骨轉移病人佔34.2% (97/284)。在97位骨轉移病人中，診斷前列腺癌時平均年齡71.5歲。轉移中軸骨多於四肢骨，69位(71.1%)病人在診斷骨轉移時有骨骼疼痛，而28位(28.8%)病人沒有。第一組中有6個病人，而在第二組有7個病人診斷骨轉移時的PSA<10ng/mL。四個病人因股骨病理性骨折接受手術，皆得到很好的疼痛解除。骨轉移後的生存率在第一、二組間並沒有統計學上的差別(P>0.05)。前列腺癌診斷時的年紀、骨轉移時的PSA值、最初的骨骼轉移位置及數量並沒有影響生存率(p>0.05)。結論 PSA值是前列腺癌病人重要的轉移與追蹤指標，當病人的PSA<10ng/mL時，骨骼轉移仍無法排除。發生骨轉移後，生存率在未治療及治療過的前列腺癌是沒有差別的，病人的年紀，PSA值及骨轉移位置亦不影響結果。
Purpose. Metastasis to bone commonly causes high morbidity and mortality rates in patients with advanced prostate cancer. Prostate-specific antigen (PSA) and bone scans are important modalities for evaluating and following the disease progression. We reviewed clinical symptoms, laboratory data, treatment and prognosis in order to analyze patients with bone-metastasized prostate cancer. Methods. From January 1995 to December 2003, a total of 284 patients with prostate cancer were admitted to the China Medical University Hospital; of them, 97 patients were diagnosed as having bone metastases. The clinical files of the 97 patients with bone metastases were reviewed. The patients were categorized into two groups: group 1 comprised those in whom primary prostate cancer and bone metastases were identified simultaneously; group 2 was composed of those with bone metastases found after identification and treatment of prostate cancer. Results. Bone metastasis was found in 34.2% (97/284 patients) of prostate cancer patients. Of the 97 patients with bone metastasis, the mean age was 71.5 years (range, 49 to 89 years) when prostate cancer was first diagnosed. Axial bones were more affected than appendicular bones. At the time bone metastasis was diagnosed, 69 patients (71.1%) had bone pain, 28 patients (28.8%) were asymptomatic and 6 patients in group 1 and 7 patients in group 2 had a serum PSA value less than 10ng/mL. Four patients underwent surgical treatment for their pathological femoral fracture, resulting in good pain relief. The survival rate after bone metastasis had developed was not statistically significant between groups 1 and 2 (p>0.05). Of the 3 factors being examined, the age at diagnosis of prostate cancer, the PSA value at first positive bone scan, and initial location and number of bone metastases did not statistically affect the survival rate in these two groups (p>0.05). Conclusions. A serum PSA level≥10ng/mL is an important marker in the metastatic work-up of prostate cancer; however bone metastases cannot be ruled out in patients with a serum PSA value of less than 10ng/mL. There was no difference in the survival rate between untreated and treated prostate cancer patients with bone metastases. The age of the patient, the initial PSA value and the location of bone metastases did not appear to affect the outcome of the disease.
