Prostate surgery

Benign prostatic hyperplasia is probably the most common neoplasm in man, and carcinoma of the prostate now leads the list of newly diagnosed malignancies in males. Even though there is no known direct etiologic relationship between these disorders, they are by no means mutually exclusive; if a man lives long enough, he is likely to be afflicted by one or both. Although most men will not require surgery, the increasing size of the geriatric population and the frequency of these disorders result in a problem of impressive magnitude from both a medical and a socioeconomic standpoint. Newer diagnostic and therapeutic modalities continue to evolve in this rapidly changing field. In many areas, further investigation is required to determine the true value of certain techniques, such as transrectal ultrasonography for screening or magnetic resonance imaging for staging of prostate cancer. Controversy now exists regarding the relative safety of transurethral and open surgical techniques for benign disease, and further comparisons will need to be made with the newer, less invasive interventional and pharmacologic techniques that are being developed. Will the advances in radical surgery result in improved survival of patients with localized prostate cancer? These and other questions will need to be addressed by the primary care physicians, geriatricians, and urologists who care for these patients.