LOCALIZED CARCINOMA OF THE PROSTATE - A PARADIGM OF UNCERTAINTY

The incidence and prevalence of prostate cancer is increasing. A numbe r of aetiological factors including age, race, family history and diet have been implicated. The majority of patients present with disease w hich is amenable only to palliation. Digital rectal examination, serum prostate-specific antigen and transrectal ultra-sound can lead to a p rostatic biopsy. Transrectal ultrasound, magnetic resonance imaging, b one scan and a chest X-ray are used for staging. The management of loc alised cancer is shrouded in uncertainty. Three options exist, watchfu l waiting, radiotherapy, and radical total prostatectomy. The publishe d data are inadequate for a valid comparison of these, and none has be en shown to offer an advantage. Surgery, and to a lesser degree radiot herapy, have a significant morbidity. It is hoped that through better understanding our management of this disease will improve.