Carcinoma of the prostate: pathology, staging, and treatment

Prostate cancer is the most common malignancy affecting American men over the age of 50. Its incidence increases with each decade. It is usually discovered by rectal examination performed during physical examination or incidentally found on histologic sections of a prostate removed to alleviate urinary obstructive symptoms. About 50% of patients have clinically localized disease at presentation. The majority of prostate cancers grow slowly, metastasize late, and are not the primary cause of death. Before recommending treatment to a patient with prostate cancer, the treating physician should assess the extent of malignancy and determine which therapy, if any, would favorably influence the course of disease with the least influence on the general quality of life. Patients with disease limited to the prostate are offered curative therapy with either radical prostatectomy or radiation therapy. Those with locally extensive disease are treated with external beam irradiation or with androgen ablation. Metastatic disease is treated by androgen ablation. Chemotherapy is reserved for those patients who fail hormonal treatment.