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Original research
Local and systemic morbidities of de novo metastatic prostate cancer in Singapore: insight from 685 consecutive patients from a large prospective Uro-oncology registry
  1. Yu Guang Tan1,
  2. Leonard Pang2,
  3. Farhan Khalid2,
  4. Randy Poon2,
  5. Hong Hong Huang1,
  6. Kenneth Chen1,
  7. Kae Jack Tay1,
  8. Weber Lau1,
  9. Christopher Cheng1,
  10. Henry Ho1,
  11. John Yuen1
  1. 1Department of Urology, Singapore General Hospital, Singapore, Singapore
  2. 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  1. Correspondence to Dr Leonard Pang; leonardpjw{at}


Objective To evaluate the incidence and management of local and systemic complications afflicting patients with de novo metastatic prostate cancer (mPCa) in Singapore.

Design Retrospective analysis of a large prospective Uro-oncology registry of mPCa.

Setting This study is carried out in a tertiary hospital in Singapore.

Participants We reviewed our institution’s prospectively maintained database of 685 patients with mPCa over a 20-year period (1995–2014). Patients with non-mPCa or those progressed to metastatic disease after previous curative local treatments were excluded.

Primary and secondary outcome measures The primary outcome was to evaluate the systemic and local morbidity rates associated with mPCa. Local complication was defined as the need for palliative procedures to relieve urinary obstruction, worsening renal function or refractory haematuria, while systemic complication was related to radiographic evidence of skeletal-related pathological fractures. Secondary outcomes analysed were the management and overall survival patterns over 20 years.

Results 237 (34.6%) patients required local palliative treatments. 88 (12.8%) patients presented with acute urinary retention, 23 patients (9.7%) required repetitive local palliative treatments. On multivariate analyses, prostate-specific antigen >100 (p=0.02) and prostate volume >50 g (p=0.03) were independent prognostic factors for significant obstruction requiring palliative procedures. 118 (17.2%) patients developed skeletal fractures, with poor Eastern Cooperative Oncology Group Performance (ECOG) status (p=0.01) and high volume bone metastasis (p<0.01) independently predictive of skeletal fractures. Altogether, 653 (95.3%) patients received androgen deprivation therapy (ADT), with the median time to castrate resistance of 21.4 months (IQR 7–27). The median overall survival was 45 months (IQR 20–63), with prostate cancer mortality of 81.4%. Improved overall survival was observed from 41.6 months (1995–1999) to 47.8 months (2010–2014) (p<0.01).

Conclusion Morbidities and complications arising from mPCa are more common and debilitating than we thought, often requiring immediate palliative treatments, while many necessitate repeated interventions with progression.

  • prostate disease
  • metastasis
  • channel TURP
  • SRF
  • morbidity

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  • Contributors YGT: Project development, data collection or management, data analysis, manuscript writing. LP and RP: Data collection or management, manuscript writing. FK and KC: Manuscript writing, critical revision of the manuscript. HHH: Data collection or management, data analysis. KJT, WL, CC and HH: Project development, critical revision of the manuscript. JY: Project development, data analysis, critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (SingHealth Institutional Review Board 2009/1053/D) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. No additional data available.

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