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. 1997 Nov;73(865):691–696. doi: 10.1136/pgmj.73.865.691

Localised carcinoma of the prostate: a paradigm of uncertainty.

S S Sandhu 1, A V Kaisary 1
PMCID: PMC2431575  PMID: 9519179

Abstract

The incidence and prevalence of prostate cancer is increasing. A number of aetiological factors including age, race, family history and diet have been implicated. The majority of patients present with disease which is amenable only to palliation. Digital rectal examination, serum prostate-specific antigen and transrectal ultrasound can lead to a prostatic biopsy. Transrectal ultrasound, magnetic resonance imaging, bone scan and a chest X-ray are used for staging. The management of localised cancer is shrouded in uncertainty. Three options exist, watchful waiting, radiotherapy, and radical total prostatectomy. The published data are inadequate for a valid comparison of these, and none has been shown to offer an advantage. Surgery, and to a lesser degree radiotherapy, have a significant morbidity. It is hoped that through better understanding our management of this disease will improve.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adolfsson J., Carstensen J., Löwhagen T. Deferred treatment in clinically localised prostatic carcinoma. Br J Urol. 1992 Feb;69(2):183–187. doi: 10.1111/j.1464-410x.1992.tb15493.x. [DOI] [PubMed] [Google Scholar]
  2. Andriole G. L., Catalona W. J. Using PSA to screen for prostate cancer. The Washington University experience. Urol Clin North Am. 1993 Nov;20(4):647–651. [PubMed] [Google Scholar]
  3. Bagshaw M. A., Kaplan I. D., Cox R. C. Prostate cancer. Radiation therapy for localized disease. Cancer. 1993 Feb 1;71(3 Suppl):939–952. doi: 10.1002/1097-0142(19930201)71:3+<939::aid-cncr2820711409>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
  4. Benson M. C., Whang I. S., Pantuck A., Ring K., Kaplan S. A., Olsson C. A., Cooner W. H. Prostate specific antigen density: a means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol. 1992 Mar;147(3 Pt 2):815–816. doi: 10.1016/s0022-5347(17)37393-7. [DOI] [PubMed] [Google Scholar]
  5. Bezzi M., Kressel H. Y., Allen K. S., Schiebler M. L., Altman H. G., Wein A. J., Pollack H. M. Prostatic carcinoma: staging with MR imaging at 1.5 T. Radiology. 1988 Nov;169(2):339–346. doi: 10.1148/radiology.169.2.3174982. [DOI] [PubMed] [Google Scholar]
  6. Blackwell K. L., Bostwick D. G., Myers R. P., Zincke H., Oesterling J. E. Combining prostate specific antigen with cancer and gland volume to predict more reliably pathological stage: the influence of prostate specific antigen cancer density. J Urol. 1994 Jun;151(6):1565–1570. doi: 10.1016/s0022-5347(17)35303-x. [DOI] [PubMed] [Google Scholar]
  7. Blackwell K. L., Bostwick D. G., Myers R. P., Zincke H., Oesterling J. E. Combining prostate specific antigen with cancer and gland volume to predict more reliably pathological stage: the influence of prostate specific antigen cancer density. J Urol. 1994 Jun;151(6):1565–1570. doi: 10.1016/s0022-5347(17)35303-x. [DOI] [PubMed] [Google Scholar]
  8. Brawer M. K., Aramburu E. A., Chen G. L., Preston S. D., Ellis W. J. The inability of prostate specific antigen index to enhance the predictive the value of prostate specific antigen in the diagnosis of prostatic carcinoma. J Urol. 1993 Aug;150(2 Pt 1):369–373. doi: 10.1016/s0022-5347(17)35485-x. [DOI] [PubMed] [Google Scholar]
  9. Carter H. B., Pearson J. D., Metter E. J., Brant L. J., Chan D. W., Andres R., Fozard J. L., Walsh P. C. Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA. 1992 Apr 22;267(16):2215–2220. [PMC free article] [PubMed] [Google Scholar]
  10. Catalona W. J., Smith D. S., Ratliff T. L., Dodds K. M., Coplen D. E., Yuan J. J., Petros J. A., Andriole G. L. Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med. 1991 Apr 25;324(17):1156–1161. doi: 10.1056/NEJM199104253241702. [DOI] [PubMed] [Google Scholar]
  11. Cooner W. H., Mosley B. R., Rutherford C. L., Jr, Beard J. H., Pond H. S., Terry W. J., Igel T. C., Kidd D. D. Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol. 1990 Jun;143(6):1146–1154. doi: 10.1016/s0022-5347(17)40211-4. [DOI] [PubMed] [Google Scholar]
  12. Dähnert W. F., Hamper U. M., Walsh P. C., Eggleston J. C., Sanders R. C. The echogenic focus in prostatic sonograms, with xeroradiographic and histopathologic correlation. Radiology. 1986 Apr;159(1):95–100. doi: 10.1148/radiology.159.1.3513254. [DOI] [PubMed] [Google Scholar]
  13. Epstein J. I., Carmichael M. J., Pizov G., Walsh P. C. Influence of capsular penetration on progression following radical prostatectomy: a study of 196 cases with long-term followup. J Urol. 1993 Jul;150(1):135–141. doi: 10.1016/s0022-5347(17)35415-0. [DOI] [PubMed] [Google Scholar]
  14. George N. J. Natural history of localised prostatic cancer managed by conservative therapy alone. Lancet. 1988 Mar 5;1(8584):494–497. doi: 10.1016/s0140-6736(88)91294-9. [DOI] [PubMed] [Google Scholar]
  15. Gibbons R. P., Correa R. J., Jr, Brannen G. E., Weissman R. M. Total prostatectomy for clinically localized prostatic cancer: long-term results. J Urol. 1989 Mar;141(3):564–566. doi: 10.1016/s0022-5347(17)40895-0. [DOI] [PubMed] [Google Scholar]
  16. Gibbons R. P. Localized prostate carcinoma. Surgical management. Cancer. 1993 Nov 15;72(10):2865–2812. doi: 10.1002/1097-0142(19931115)72:10<2865::aid-cncr2820721002>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  17. Hodge K. K., McNeal J. E., Stamey T. A. Ultrasound guided transrectal core biopsies of the palpably abnormal prostate. J Urol. 1989 Jul;142(1):66–70. doi: 10.1016/s0022-5347(17)38663-9. [DOI] [PubMed] [Google Scholar]
  18. Hodge K. K., McNeal J. E., Terris M. K., Stamey T. A. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989 Jul;142(1):71–75. doi: 10.1016/s0022-5347(17)38664-0. [DOI] [PubMed] [Google Scholar]
  19. Johansson J. E., Adami H. O., Andersson S. O., Bergström R., Krusemo U. B., Kraaz W. Natural history of localised prostatic cancer. A population-based study in 223 untreated patients. Lancet. 1989 Apr 15;1(8642):799–803. doi: 10.1016/s0140-6736(89)92269-1. [DOI] [PubMed] [Google Scholar]
  20. Kabalin J. N., McNeal J. E., Johnstone I. M., Stamey T. A. Serum prostate-specific antigen and the biologic progression of prostate cancer. Urology. 1995 Jul;46(1):65–70. doi: 10.1016/S0090-4295(99)80161-7. [DOI] [PubMed] [Google Scholar]
  21. Lentle B. C., McGowan D. G., Dierich H. Technetium-99M polyphosphate bone scanning in carcinoma of the prostate. Br J Urol. 1974 Oct;46(5):543–548. doi: 10.1111/j.1464-410x.1974.tb03854.x. [DOI] [PubMed] [Google Scholar]
  22. McCarthy P., Pollack H. M. Imaging of patients with stage D prostatic carcinoma. Urol Clin North Am. 1991 Feb;18(1):35–53. [PubMed] [Google Scholar]
  23. McClennan B. L. Transrectal US of the prostate: is the technology leading the science? Radiology. 1988 Aug;168(2):571–575. doi: 10.1148/radiology.168.2.3293115. [DOI] [PubMed] [Google Scholar]
  24. Middleton R. G., Thompson I. M., Austenfeld M. S., Cooner W. H., Correa R. J., Gibbons R. P., Miller H. C., Oesterling J. E., Resnick M. I., Smalley S. R. Prostate Cancer Clinical Guidelines Panel Summary report on the management of clinically localized prostate cancer. The American Urological Association. J Urol. 1995 Dec;154(6):2144–2148. [PubMed] [Google Scholar]
  25. Narayan P., Fournier G., Gajendran V., Leidich R., Lo R., Wolf J. S., Jr, Jacob G., Nicolaisen G., Palmer K., Freiha F. Utility of preoperative serum prostate-specific antigen concentration and biopsy Gleason score in predicting risk of pelvic lymph node metastases in prostate cancer. Urology. 1994 Oct;44(4):519–524. doi: 10.1016/s0090-4295(94)80050-2. [DOI] [PubMed] [Google Scholar]
  26. Partin A. W., Carter H. B., Chan D. W., Epstein J. I., Oesterling J. E., Rock R. C., Weber J. P., Walsh P. C. Prostate specific antigen in the staging of localized prostate cancer: influence of tumor differentiation, tumor volume and benign hyperplasia. J Urol. 1990 Apr;143(4):747–752. doi: 10.1016/s0022-5347(17)40079-6. [DOI] [PubMed] [Google Scholar]
  27. Paulson D. F., Moul J. W., Walther P. J. Radical prostatectomy for clinical stage T1-2N0M0 prostatic adenocarcinoma: long-term results. J Urol. 1990 Nov;144(5):1180–1184. doi: 10.1016/s0022-5347(17)39686-6. [DOI] [PubMed] [Google Scholar]
  28. Phillips M. E., Kressel H. Y., Spritzer C. E., Arger P. H., Wein A. J., Marinelli D., Axel L., Gefter W. B., Pollack H. M. Prostatic disorders: MR imaging at 1.5 T. Radiology. 1987 Aug;164(2):386–392. doi: 10.1148/radiology.164.2.2440074. [DOI] [PubMed] [Google Scholar]
  29. Platt J. F., Bree R. L., Schwab R. E. The accuracy of CT in the staging of carcinoma of the prostate. AJR Am J Roentgenol. 1987 Aug;149(2):315–318. doi: 10.2214/ajr.149.2.315. [DOI] [PubMed] [Google Scholar]
  30. Rifkin M. D., Dähnert W., Kurtz A. B. State of the art: endorectal sonography of the prostate gland. AJR Am J Roentgenol. 1990 Apr;154(4):691–700. doi: 10.2214/ajr.154.4.1690499. [DOI] [PubMed] [Google Scholar]
  31. SPRING W. B., ALDEN M. W. An evaluation of the needle biopsy in the diagnosis of prostatic carcinoma. Can Med Assoc J. 1954 Feb;70(2):179–185. [PMC free article] [PubMed] [Google Scholar]
  32. Scardino P. T., Shinohara K., Wheeler T. M., Carter S. S. Staging of prostate cancer. Value of ultrasonography. Urol Clin North Am. 1989 Nov;16(4):713–734. [PubMed] [Google Scholar]
  33. Scardino P. T., Weaver R., Hudson M. A. Early detection of prostate cancer. Hum Pathol. 1992 Mar;23(3):211–222. doi: 10.1016/0046-8177(92)90102-9. [DOI] [PubMed] [Google Scholar]
  34. Seaman E. K., Whang I. S., Cooner W., Olsson C. A., Benson M. C. Predictive value of prostate-specific antigen density for the presence of micrometastatic carcinoma of the prostate. Urology. 1994 May;43(5):645–648. doi: 10.1016/0090-4295(94)90179-1. [DOI] [PubMed] [Google Scholar]
  35. The impact of current staging procedures in assessing disease extent of prostatic adenocarcinoma. J Urol. 1979 Mar;121(3):300–302. doi: 10.1016/s0022-5347(17)56761-0. [DOI] [PubMed] [Google Scholar]
  36. Waxman J., Sheer D. Is prostate cancer worth diagnosing? Lancet. 1995 Nov 4;346(8984):1177–1178. doi: 10.1016/s0140-6736(95)92895-2. [DOI] [PubMed] [Google Scholar]
  37. Whitmore W. F., Jr, Warner J. A., Thompson I. M., Jr Expectant management of localized prostatic cancer. Cancer. 1991 Feb 15;67(4):1091–1096. doi: 10.1002/1097-0142(19910215)67:4<1091::aid-cncr2820670437>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]

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