ISSUES ON EARLY DIAGNOSIS AND TREATMENT OF LOCALIZED PROSTATE-CANCER

Controversies abound in relation to the treatment of every stage of pr ostate cancer and its natural history. We critically evaluate the cont roversies and information that exist. An ongoing autopsy project at Wa yne State University aims to: define the prevalence of incidental canc er in subjects between 20 and 70 years of age; study the potential dif ference between Caucasians and Blacks; and to analyze other associated histological lesions such as prostatic intraepithelial neoplasia (PIN ) and atypical adenomatous hyperplasia. Initial results note that ther e was only a weak correlation between high-grade PIN and incidental ca rcinoma, both lesions started to present at an early age with a progre ssive increase after the seventh decade, and there was no racial diffe rence observed among Caucasians and African-American males. These resu lts pose several questions which need further explanation. Most studie s use digitorectal examination, transrectal 7-MHz ultrasonography and prostate-specific antigen for the early diagnosis of prostate cancer, we attempt to determine the best and most economical combination prese ntly available. In discussing the therapeutic options for patients wit h localized prostate cancer, we review our personal experience with su rgery and radiotherapy.