If prostate cancer has spread to distant organs, current therapy will not cure it. Median survival is usually 1 to 3 years, and the majority of such patients will die of prostate cancer. Even in this group of patients, however, indolent clinical courses lasting for many years may be observed. 10-14 Poorly differentiated tumors are more likely to have already metastasized by the time of diagnosis and are associated with a poorer prognosis. In the majority of studies, flow cytometry has shown that nuclear DNA ploidy is an independent prognostic indicator for progression and for cause-specific survival in patients with pathologic stages C and D1.
Diploid tumors have a more favorable outcome than either tetraploid or aneuploid tumors.
The use of flow cytometry techniques, histogram analysis, and computer-assisted cell morphology as tools to determine prognosis will require standardization. 16-20 Definitive treatment is usually considered for younger men with prostate cancer and no major comorbid medical illnesses since they are more likely to die of prostate cancer than older men or men with major comorbid medical illness. Elevations of serum acid phosphatase are associated with poor prognosis in both localized and disseminated disease. PSA, an organ-specific marker with greater sensitivity and high specificity for prostate tissue, is often used as a tumor marker. After radical prostatectomy, detectable PSA levels indicate local treatment failure or metastatic disease.