External beam versus brachy therapy in localized prostatic cancer

Adenocarcinoma of the prostate: innovations in management

Adenocarcinoma of the prostate (CaP) in the Western world has become the most common noncutaneous human tumor. CaP is also the second most important cause of cancer deaths among the male population in the United States. Major progress was made in the past decade in better understanding this disease process, as well as in improved diagnostic accuracy. This improved diagnostic accuracy was due to wide application of prostate-specific antigen (PSA), use of transrectal ultrasound (TRUS), and greater awareness among clinicians of CaP. The use of PSA in clinical practice has resulted in a sharp increase in the number of patients diagnosed with capsule-confined tumors. The optimal treatment for capsule-confined CaP is in the process of being defined. Radical prostatectomy in the United States is currently the most commonly applied treatment for younger patients. Excellent treatment results with a 10-year actuarial survival > 80% are readily obtainable in properly selected patients. Nerve-sparing procedures helped reduce the high incidence of impotence that occurs in patients after radical retropubic prostatectomy. Radiotherapy remains the other curative treatment method in the management of CaP patients, with long-term survival rates similar to those reported in surgical series. Due to the problem of frequent preoperative tumor understaging, a routine use of postoperative irradiation to the prostatic fossa produces an excellent (> 95%) incidence of local tumor control. Management of patients with metastatic disease has undergone a considerable evolution with the development of modern hormonal management and treatment with strontium-89 to control intractable bone pain. Newer treatment methods such as hyperthermia are currently being investigated. Major efforts are directed toward the reduction of short- and long-term treatment toxicity associated with surgery, radiotherapy, and hormonal management, thus improving patient quality of life.

125Iodine implantation after lymphadenectomy in early carcinoma of the prostate

The interim results of planned lymphadenectomy and 125Iodine implantation for carcinoma of the prostate in 122 patients are reported. The incidence of positive pelvic lymph nodes found at lymphadenectomy ranged from 15% in A-2 to 55% in B-2 lesions, as well as in 13% of well-differentiated tumors. Poorly differentiated histology, B-2 and D-1 tumors, had early treatment failure indicating a group of patients in whom this procedure is contraindicated. Occult disease (A-2) and well-differentiated tumors do not exhibit early failure. However, these patients will also fare well with radical external radiation or prostatectomy. The radiobiology of the low dose rate continuous irradiation of 125Iodine is questioned. It may be inadequate for long-term tumor control. Longer follow-up of this series may indicate that external radiation for clinically localized carcinoma of the prostate is the most effective treatment policy.