Management of metastatic prostatic cancer

Since 1973, two studies covering a 10-year period in the United States were conducted by the Commission on Cancer of the American College of Surgeons. Participating hospitals from over 1,200 institutions contributed over 70,000 cases to this report and review. These hospitals represent nearly 80% of the newly diagnosed cancer cases in the United States annually at the present time. From these studies, certain confirmations of trends in the general treatment at the local level for prostate cancer were observed. For example, there was an overall reduction in the number of patients receiving hormone treatment for localized prostate cancer. At the same time during this study, more patients received external radiotherapy or surgery for the localized lesions. Disseminated newly diagnosed prostate cancer was equally treated by orchiectomy or diethylstilbestrol. A distinct relationship was observed between the grade of the tumor and the stage. In the latter 5-year period of this observation time, more patients were graded by pathologists upon diagnosis at their community hospital than previously. This exceeded over 85% and represented a remarkable conversion. The more frequent grading system used was that employed and described by Gleason. More extensive use of bone scans over a 10-year period on initial evaluation was also reported. Other patterns of care relating to national trends and incidences will be described. The American black male has the highest incidence of prostate cancer in the world. Grade for grade, stage for stage, these men do less well regardless of treatment than their white counterparts. (Schmidt, 1986) These factors will have to be further studied.