The Nonsurgical Treatment of Prostatic Carcinoma

Abstract

Publisher Summary This chapter describes the nonsurgical treatment of prostatic carcinoma. The carcinoma of the prostate often remains undetected until it causes either obstructive urinary symptoms or symptoms caused by distant spread, usually pain. The relevance of the presentation and the natural history of the disease has become of major importance because of the mortality and morbidity that can occur when estrogen therapy is given to a patient with early-stage tumor. Lymphatic spread is a common feature of prostatic carcinoma and occurs with increasing frequency as the primary tumor stage progresses. The regional nodes lie along the iliac vessels and cannot be assessed clinically. In advanced disease, there may be evidence of metastases to superficial nodes in the groins, axillae, and supraclavicular fossae. Rectal examination under anesthesia with adequate muscular relaxation can be a useful adjunct in staging and permits a better assessment of extraprostatic spread, particularly in the region of the seminal vesicles. It is found that reduction of plasma testosterone is achieved within about 7 days using doses of stilbestrol varying from 100 mg three times daily. It is suggested that survival following castration-estrogen therapy was better than the survival following either therapy alone, and especially for those patients without metastases on the first admission.