Consensus Development Conference on the Management of Clinically Localized Prostate Cancer. Overview: historical and...

Recognition of the clinical importance of prostate cancer undoubtedly was delayed by the failure of clinicians or pathologists to distinguish consistently between benign and malignant prostatic growths until well into the 19th century. White used castration for prostatic enlargements in 1895, but Huggins and Hodges first placed endocrine therapy on a rational basis in 1941. Although a number of surgeons had attempted excision of prostate cancer, Young is credited with planning and performing the first radical perineal prostatectomy in 1904. Orthovoltage irradiation and various techniques of interstitial and intracavitary radium therapy were used in the treatment of prostate cancer early in the 20th century, but it was the development of megavoltage irradiation that reopened the door to the exploration of irradiation for localized prostate cancer following World War II. Endocrine manipulation, surgery, and irradiation remain the keystones of treatment. The management of prostate cancer is controversial for several reasons: 1) The disease occurs in an age range in which competing causes of mortality are high. 2) The natural evolution of the disease is varied, often long, and not consistently predictable. 3) Long-term survival has been reported for each of the principal modes of therapy, but randomized controlled studies have been limited. Uniformity in histologic grading, clinical staging, and evaluation of response to treatment would improve the quality of the data. Predictions of host life expectancy, tumor growth rate, metastatic potential, and tumor responsiveness to irradiation and endocrine therapy would enhance the rationale of treatment.