A current view of prostatic cancer

Carcinoma of the prostate is the third leading type of cancer in men over the age of fifty-five. This adenocarcinoma of unclear cause has a unique geographical distribution suggesting an environmental factor. Most patients present with metastatic disease, and definitive surgery or radiotherapy is curative in only ten percent of cases. The only reliable biologic marker for prostatic carcinoma is acid phosphatase. The treatment of metastatic disease remains controversial. Subjective relief of symptoms can be obtained in the majority of patients with either the use of DES or castration, but overall survival benefit is minimal. However, subsets of patients, excluding either high or low pathologic grades of tumor do appear to have survival benefit. The chemotherapy of prostatic carcinoma remains one of the most neglected areas of medical oncology, but in patients failing hormonal therapies, 20% to 30% may benefit from either single or combination chemotherapy.