Carcinoma of the Prostate

Innovations in Management

The American Cancer Society anticipates that during 1995, 244000 new cases of cancer of the prostate will have been diagnosed in the United States, with 40400 deaths from the disease process. The rapid increase in the actual number of new cases in the United States is directly related to more regularized digital rectal examinations and the more frequent and widespread use of prostate-specific antigen (PSA) screening programs. As a conse­ quence, major controversies have emerged in how best to manage the patient with cancer of the prostate. These include the necessity of PSA screening programs, how to interpret PSA values, what imaging studies are most appropriate for definition of the true extent of the disease process, the value of pretreatment surgical staging of the disease process, and the value of different treatments. The latter encompass a wide range of options: observa­ tion, radical prostatectomy, the Walsh-type prostatectomy procedure, definitive external beam radiation therapy, local interstitial implantation using iodine-125, iridium-l92, or palladium-103, orchiectomy, cryosurgery, hyperthermia, and various antitestosterone agents such as estrogens or LH,RH agonists. The present volume deals with the major parameters of controversy with regard to cancer of the prostate and will enable the reader to acquire a better understanding of the disease and how best it might be managed to achieve an optimal outcome with a minimum of complications.