To investigate the prognosis and predictive factors of primary metastatic prostate carcinoma (M1CaP) in men younger than 60 years. Methods : From April 1986 to December 1999, 18 patients with M1CaP were enrolled. Cause-specific and progression-free surival rates were estimated using the Kaplan-Meier method and compared with those of patients aged over 60 years with M1CaP in the same time period. Results : The 5-and 10-year cause-specific survival rates were 33.7% and 0%, respectively, in the younger men compared with 57.1% and 41.9%, respectively, in the older age group (p<0.001). In multivariate analysis using Cox's proportional hazards model for cause-specific survival, pretreatment serum PSAwas the only significant predictor (p<0.02). Conclusions : The prognosis of M1CaP in men younger than 60 is worse than for those aged over 60. Therefore, it is necessary to use a combination therapy (e. g. hormonal plus chemotherapy) for these patients.
Stercoral perforation of the colon is a direct result of ischemic pressure necrosis by a stercoraceous mass. We present a case of the stercoral perforation of the rectum combining recto-vaginal and recto-cutaneous fistulae. A 79-year-old woman was admitted to hospital for pain and swelling of the perineal region. The patient was diagnosed as having a rectal perforation forming a recto-vaginal fistula and a recto-cutaneous fistula. In the primary procedure, sigmoid colon impacted with feces was transected and a colostomy was formed. After closing the abdominal wall, the necrotic perineal region was debrided. The second operation was carried out 1 month after the first one. The remnants of the rectum and anus were excised, and the perforated portion of the vaginal posterior wall was sewed up from the outside. It appeared effective to divide the operation into two distant phases.