The present status of radical prostatectomy for stages A and B prostatic cancer

The natural history of prostatic cancer is incompletely understood. Small cancers may have a very slow or rapid growthrate, and the majority are differentiated. Cells may leave the prostate by blood or lymph without penetrating capsule or invading the seminal vesicles. The predication of latency or of biologic activity in any givne case is impossible. Stage A cancer should be separated into A1 (focal) and A2 (diffuse). Stage A1 cancer that is low grade is best lfet alone. Stage A2 cancer and high grade cancer probably should be treated by megavoltage radiation. Stage B includes many cancers that are microscopically stage C. If this stage is separated into clinical stage B1 (tumors grossly involving less than one lobe), and B2 (tumors involving one lobe or more) the underestimation of microscopic extent in B1 will be less than in 10 per cent of the cases. In clinical stage B2 cancer, 50 per cent are microscopically stage C. Radical prostatectomy for cure should be limited to clinical B1 cases without distant spread. It is not a cure-all, but it provides the best 15-year survival rate more completely, more quickly, less expensively, and with fewer discomforts than other methods. The alternative options are no treatment, endocrine treatment, and radiation. The first is risky in many instances and may allow an ac-ive cancer to get out of control. The second rarely destroys all of the cells in the total cell population and gives one a false sense of security. The last should be reserved for cases well beyond stage B1, but without distant metastases, where its usefulness exceeds that of radical excision.