Therapeutic Options for Clinically Localized Carcinoma of the Prostate

Clinically localized carcinoma of the prostate is diagnosed annually in over 50,000 American men. The advent of screening programs using digital rectal examination, transrectal ultrasound, and assays for prostatic specific antigen will increase the magnitude of this public health problem. The range of treatment options for this disease includes observation, radical prostatectomy, external beam irradiation, and adjuvant hormonal manipulation. Close surveillance of incidentally diagnosed carcinoma of the prostate achieves cause-specific survivorship in excess of 95%. Organ-confined disease can be approached equally effectively by either radical prostatectomy or definitive external irradiation. Radioactive implantation of organ-confined disease has resulted in inferior local control when compared with locally irradiated patients. For tumors extending to the prostatic capsule, external irradiation must be the cornerstone of management. Neoadjuvant hormonal manipulation has failed to render locally advanced disease resectable; however, exciting data are emerging from centers administering hormones as an adjunct to external irradiation. The latter approach is the basis of an ongoing Radiation Therapy Oncology Group trial.