Locoregional prostatic cancer. Advances in management

Conceptual advances include attempts to achieve uniformity among systems for characterizing and reporting experiences with prostatic cancer, better understanding of the zonal anatomy of the prostate, and recognition of probable precursor lesions to prostatic cancer. Prostatic-specific antigen, transrectal ultrasonography, and fine-needle aspiration biopsy are major innovations in diagnosis and staging of prostatic cancer. The varied and unpredictable behavior of prostatic cancer has stimulated the search for reliable indicators of the biologic potential of the disease. Management of localized prostatic cancer remains controversial. A nerve-sparing technique of radical retropubic prostatectomy accomplishes total removal of the prostate with possible preservation of sexual potency. Linear accelerator irradiation is an acceptable alternative treatment. Interstitial irradiation with a variety of radionuclides remains under investigation using ultrasound to enhance distribution of radiation sources. Endocrine therapy may prove especially advantageous if administered before development of bone metastasis.