Diagnosis and management of prostate cancer

Representing 18% of male cancers, carcinoma of the prostate gland is the second most common cancer and the third leading cause of cancer deaths in US males. In 1982, it is estimated 73,000 new cases and 23,000 deaths will occur from the most common cancer in men older than 65 years of age. US blacks have the highest incidence in the world. Annual rectal digital examination of the prostate gland discovering a suspicious nodule or indurated area of the gland remains the earliest means of detection of the prostatic cancer in the asymptomatic man. However, more commonly the earliest unsuspected detection occurs in the surgical specimen removed following operations to relieve obstructive symptoms of benign prostatism. Survival of patients with this disease correlates with the stage and grade of disease at time of diagnosis, consequently it is imperative to ascertain the extent of disease in order to select the appropriate therapy for the patient. Radical prostatectomy, interstitial radiation implantation, and external radiation are the current means of treatment patients with low-stage disease, while hormonal manipulation alone or in combination with external radiation and chemotherapy are the primary means of treatment symptomatic patients with carcinoma of the prostate. The expected five-year survival for low-stage disease is 70-80%.