Radio-Active Substances and Their Therapeutic Uses and Applications

Abstract

MALIGNANCY of the prostate in some respects offers more difficulties to the physician who attempts to cope with it than does any other growth of this character elsewhere located. There are several reasons for this. Obviously, its sequestered situation makes it less easy of access than neoplasms nearer the surface, but aside from this, several other factors combine to render the control of the malignancy in this gland an especially difficult problem. Very often the disease will be far advanced before there is the slightest indication of its presence, and even when symptoms do appear they are those common to a number of disturbances in the urogenital tract, and not sufficiently characteristic of prostatic cancer to immediately suggest the possible existence of that lesion. Thus much valuable time is likely to be lost, and when the diagnosis is finally made the patient is all too frequently beyond the aid of any treatment. Early metastasis is especially characteristic of prostatic neoplasms. Extension to the bladder is very common, because, as one of wide experience with these growths has recently pointed out, the gland lying between the dense fascia of Denonvillier and the firm, though somewhat more yielding, fascia forming the base of the bladder, offers the invading growth practically no room for expansion except by metastasis. Moreover, the contraction of the vesical sphincter after each micturition exerts a frequently recurring pressure upon the growth that would seem especially likely to induce early invasion of the bladder, and very probably contributes not a little to the encouragement of early metastasis. If it is purposed to employ radium treatment, measures should always be taken to ascertain whether or not metastasis has occurred. Glandular involvement is commonly detected easily, but as cancer of the prostate is likely to extend to the lumbosacral region and to the chest, only thorough examination by roentgenography will serve to give definite information as to whether or not the malignancy is still localized in the prostatic region. If secondary foci are found it should be realized that treatment by radium offers little beyond palliation. The pain in the back and extremities which is so often a distressing feature of cases where the sacral region is involved, may frequently be much lessened or even entirely abolished following radium applications. More than 60 per cent of the patients reported by Deming as suffering from pain in the back were entirely relieved of this symptom after radium treatment. Bumpus, however, takes quite an opposite view of the advantages of radium under such conditions.