ADENOCARCINOMA OF THE PROSTATE - INNOVATIONS IN MANAGEMENT

Adenocarcinoma of the prostate (CaP) in the Western world has become t he most common noncutaneous human tumor. Cap is also the second most i mportant cause of cancer deaths among the male population in the Unite d States. Major progress was made in the past decade in better underst anding this disease process, as well as in improved diagnostic accurac y. This improved diagnostic accuracy was due to wide application of pr ostate-specific antigen (PSA), use of transrectal ultrasound (TRUS), a nd greater awareness among clinicians of CaP. The use of PSA in clinic al practice has resulted in a sharp increase in the number of patients diagnosed with capsule-confined tumors. The optimal treatment for cap sule-confined CaP is in the process of being defined. Radical prostate ctomy in the United States is currently the most commonly applied trea tment for younger patients. Excellent treatment results with a 10-year actuarial survival >80% are readily obtainable in properly selected p atients. Nerve-sparing procedures helped reduce the high incidence of impotence that occurs in patients after radical retropubic prostatecto my. Radiotherapy remains the other curative treatment method in the ma nagement of CaP patients, with long-term survival rates similar to tho se reported in surgical series. Due to the problem of frequent preoper ative tumor understaging, a-routine use of postoperative irradiation t o the prostatic fossa produces an excellent (>95%) incidence of local tumor control. Management of patients with metastatic disease has unde rgone a considerable evolution with the development of modern hormonal management and treatment with strontium-89 to control intractable bon e pain. Newer treatment methods such as hyperthermia are currently bei ng investigated. Major efforts are directed toward the reduction of sh ort- and long-term treatment toxicity associated with surgery, radioth erapy, and hormonal management, thus improving patient quality of life .