title: [Skip metastasis of prostate cancer: diagnosis and treatment].
abstract: OBJECTIVE
  To improve the diagnosis and treatment of far advanced prostate cancer without clinically detectable bone metastasis.
  
  
  METHODS
  Cancer metastatic lesions were found in the liver and lungs respectively of two patients on routine medical examination, and only an abnormally elevated level of the serum prostate specific antigen (PSA) was observed in the following system examinations. The patients were diagnosed as having prostate cancer by prostate biopsy. MRI showed a discontinued prostate capsule, and ECT revealed no bone metastasis. Diagnostic treatment was conducted by giving LHRHa combined with antiandrogens. One of the patients underwent surgical castration at 12 months, and both received intensity modulated radiation therapy (80 Gy) at 15 and 18 months, respectively.
  
  
  RESULTS
  The metastatic lesions in the liver and lungs of the patients were either absent or significantly reduced after treated by maximal androgen blockade for 3 months, and all disappeared after 6 months'treatment, with the PSA level stabilized at less than 0.02 microg/L in one patient, and around 0.5 microg/L in the other. Antiandrogen treatment was suspended after radiotherapy. The results of liver, lung and bone scanning were normal during the 12-month follow-up, and the PSA level was below 1.0 microg/L.
  
  
  CONCLUSIONS
  Remote metastasis of prostate cancer may occur in ectosteal organs first, which deserves special attention. A combination of different treatment methods promises satisfactory results.
authors.affiliation: Department of Urology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221002, China.
authors.forename: Jun-Qi
authors.initials: JQ
authors.lastname: Wang
authors.forename: Wang
authors.initials: W
authors.lastname: Li
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wang
authors.forename: Kun
authors.initials: K
authors.lastname: Liu
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Mao
authors.forename: Jia-Cun
authors.initials: JC
authors.lastname: Chen
authors.forename: Jun-Nian
authors.initials: JN
authors.lastname: Zheng
authors.forename: Xiao-Qing
authors.initials: XQ
authors.lastname: Sun
mesh_terms: D000368:Aged; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary*; D008175:Lung Neoplasms / Q000556:secondary*; D008297:Male; D009362:Neoplasm Metastasis; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy